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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880905
Report Date: 06/21/2023
Date Signed: 06/21/2023 03:09:41 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/21/2023 and conducted by Evaluator Chinwe Nwogene
COMPLAINT CONTROL NUMBER: 18-AS-20230321093424
FACILITY NAME:TEMECULA MEMORY CAREFACILITY NUMBER:
331880905
ADMINISTRATOR:GEDDIE, JAMESFACILITY TYPE:
740
ADDRESS:44320 CAMPANULA WAYTELEPHONE:
(951) 428-4990
CITY:TEMECULASTATE: CAZIP CODE:
92592
CAPACITY:64CENSUS: 49DATE:
06/21/2023
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Azizi Baranauskas, Clinical Care CoordinatorTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Facility is charging resident additional fees to choose preferred pharmacy.
INVESTIGATION FINDINGS:
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On 6/21/2023, Licensing Program Analyst (LPA), Chinwe Nwogene conducted an unannounced visit to conclude the complaint investigation into the allegation listed above. LPA met with Clinical Care Coordinator, Azizi Baranauskas who was informed of the purpose of the visit. During the investigation, staff was interviewed, and resident’s file was reviewed.
Regarding the allegation “Facility is charging resident additional fees to choose preferred pharmacy”, it was alleged facility is charging residents fee to use out pharmacy. LPA interviewed staff who stated facility has a pharmacy the facility uses. Staff acknowledged facility charges residents a fee when a resident uses an outside pharmacy and it’s included in the resident’s admission agreement. Staff stated resident was in an all-inclusive rate when resident was admitted in the facility. Meaning the resident outside pharmacy fee was waved for the first and second year. Staff stated the outside pharmacy fee went into effect on the third year and the resident’s responsible party was given notice months in advance. Resident’s Responsible Party declined LPA’s request for interview. Resident’s admission agreement was reviewed. Resident’s admission agreement revealed use of outside pharmacy fee was included in the agreement.
Based on LPA’s interviews with staff, and resident’s file review, there is not enough evidence to support the above allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of this report was reviewed with and provided to Azizi Baranauskas.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Chinwe NwogeneTELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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