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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881115
Report Date: 07/25/2024
Date Signed: 07/25/2024 02:58:10 PM

Substantiated


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
01/09/2023 and conducted by Evaluator Janira Arreola
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230109114416
FACILITY NAME:ANGEL'S LOVING TOUCHFACILITY NUMBER:
331881115
ADMINISTRATOR:CERDA, YAZMIN S.FACILITY TYPE:
740
ADDRESS:37212 EDGEMONT DRIVETELEPHONE:
(951) 249-9041
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:6CENSUS: DATE:
07/25/2024
UNANNOUNCEDTIME BEGAN:
02:08 PM
MET WITH:Licensee, Yazmin CerdaTIME COMPLETED:
03:05 PM
ALLEGATION(S):
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Facility did not provide a refund.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to deliver findings for the above allegation. LPA met with Licensee, Yazmin Cerda, who was informed of the purpose of the visit. The investigation consisted of conducted interviews and conducted records reviews.

It was alleged that the facility did not provide a refund to R1’s family after R1 passed away 1/28/2022. A payment of $4215 was made for February 2022 to the facility before R1’s passing, of which $2000 is still outstanding back to the family of R1.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 18-AS-20230109114416
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ANGEL'S LOVING TOUCH
FACILITY NUMBER: 331881115
VISIT DATE: 07/25/2024
NARRATIVE
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LPA conducted a record review of check issued to the facility showing payment of $4215. LPA also reviewed text messages between staff #1 (S1) and R1’s family member. It was found that on 2/7/2022 a text thread was started to retrieve the amount paid to the facility. An agreement was made to pay back $4000 and pay in installments of $1000, in June, July, August and September of 2022. The text messages show efforts made by R1’s family to contact S1 resulting in an outstanding $2000 as of 1/9/2023.

LPA conducted interview with staff which revealed that S1 was hesitant to pay R1’s family member as they were not the legal representative for R1. However, the screenshots of payments made from a Zelle account show that S1 had previously been paying R1’s family member directly, and had paid $2000 to them.

Based on interviews and records reviewed, the preponderance of evidence standard has been met. The allegation that the facility did not issue a full refund is substantiated. California Health and Safety code is being cited on the attached LIC 9099 D. An exit interview was conducted, and a copy of this report was provided.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20230109114416
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ANGEL'S LOVING TOUCH
FACILITY NUMBER: 331881115
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/01/2024
Section Cited
HSC
1569.652(c)
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Health and Safety Code
(c) A refund of any fees paid in advance…shall be issued to the…entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed. This requirement was not met as evidenced by:
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The licensee agreed to send a self certified statment of understanding of the regulation section cited by the POC due date.
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Based on interviews and records review, the facility did not issue a full refund to the R1’s responsible party within the required time frame. This poses a potential health safety or personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3