336407734-12-20-2021-18-AS-JESL-CKNUXJ-20221029155826

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336407734
Report Date: 12/20/2021
Date Signed: 12/20/2021 02:29:38 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
09/11/2020 and conducted by Evaluator Crystal Colvin

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200911162021

FACILITY NAME:	PICO DE LORO		FACILITY NUMBER:	336407734
ADMINISTRATOR:	VIVIEN RILLO/EFREN RILLO		FACILITY TYPE:	740
ADDRESS:	620 NORTH PERRIS BLVD		TELEPHONE:	(951) 943-8081
CITY:	PERRIS	STATE: CA	ZIP CODE:	92571
CAPACITY:	39	CENSUS: 14	DATE:	12/20/2021
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Vivien Rillo - Administrator		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Facility failed to issue a refund

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced to follow up on the open complaint with the allegation above. LPA Colvin met with Administrator Vivien Rillo and advised of the purpose of today's visit. Below is a summary of the findings of the investigation:

Regarding allegation "Facility failed to issue a refund": LPA Colvin reviewed documents for the resident (R1) including Admissions Agreement, Narrative Charting, and communications from R1's Power of Attorney (POA) to the facility. LPA Colvin additionally iterviewed the Administrator and R1's POA regarding the allegation. The time period of concern of the complaint is June 2020 & July 2020, as R1 was not present at the facility, as R1 was hospitalized for COVID-19 and then trasnferred to a Skilled Nursing Facility (SNF) after the Licensee declined to readmit R1 until R1 had fully recovered from COVID-19. LPA Colvin learned that while the Licensee would not readmit R1 until R1 was recovered from COVID-19, the facility did not issue an eviction notice, as R1 was to be welcome back at the facility after R1 recovered.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021

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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Control Number 18-AS-20200911162021

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: PICO DE LORO	FACILITY NUMBER: 336407734
	VISIT DATE: 12/20/2021

NARRATIVE

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Additionally, in R1's Admissions Agreement under the section 14 for Refunds the contract notes that "stays in the hospital or nursing home does not form as a basis for any refund at all". Since R1 was not evicted and after R1's hospitalization was staying at a SNF pending recovery, according to the Admissions agreement, R1 would not qualify for a refund for this time period. Due to interviews and record review, the complaint is UNFOUNDED.

This agency has investigated the complaint alleging "Facility failed to issue a refund". We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted with Administrator Vivien Rillo and a copy of this report was provided.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021

LIC9099 (FAS) - (06/04)

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