336413087-12-1-2023-18-AS-JDHS-CY7R7B-20231204114600

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336413087
Report Date: 12/01/2023
Date Signed: 12/01/2023 12:16:59 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 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
08/02/2023 and conducted by Evaluator Jacqueline Shaw Ross

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20230802133907

FACILITY NAME:	BROOKDALE MURRIETA		FACILITY NUMBER:	336413087
ADMINISTRATOR:	QUEEN AYERS		FACILITY TYPE:	740
ADDRESS:	24350 JACKSON AVE		TELEPHONE:	(951) 696-5753
CITY:	MURRIETA	STATE: CA	ZIP CODE:	92562
CAPACITY:	82	CENSUS: 61	DATE:	12/01/2023
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Celia Saldivar, Business Office Manager		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff are overcharging resident in care.
Staff do not provide resident with an itemized list of charges.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Jacqueline Shaw Ross made an unannounced visit to deliver findings for the allegations noted above. LPA met with Celia Saldivar, Business Office Coordinator and explained the purpose of the visit and the elements of the allegations. The investigation consisted of observations, interviews, and records review.

On 08/02/2023, Community Care Licensing received an allegation that staff are overcharging resident in care and staff do not provide resident with an itemized list of charges. R1 and his wife (R2) share a unit at the facility together. It was alleged that R1 noticed what appeared to be a double charge on their bank statement of Personal Service charges for May 2023. Per interview with R1, stated they did not understand the charges and expressed that staff in the facility seemed unwilling to explain charges to him. LPA interviewed both R1 and R2, as well as reviewed their bank statement.

Cont'd on LIC9099C....

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross	TELEPHONE: 951-248-0314
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023

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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Control Number 18-AS-20230802133907

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BROOKDALE MURRIETA	FACILITY NUMBER: 336413087
	VISIT DATE: 12/01/2023

NARRATIVE

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Cont'd from LIC 9099....

LPA then interviewed Business Office Manager who informed LPA that R1 previously inquired on May 19, 2023, about an itemized list of charges and again last week. Business Office Manager states she discussed requested information directly to R1 on 05/19/23. Business Office Manager states she offered R1 documents detailing the Personal Service charges for the months in question, but R1 declined. During the complaint investigation visit, LPA witnessed a verbal exchange between R1 and Business Office Manager, in which R1 was provided a copy of R1's Personal Rate Increase account statement for the months of March 2023 thru May 2023. R1 indicated that he now understood the charges and that there was no discrepancy. R1 also indicated he did recall a conversation with the Business Office Manager in May 2023 in which she explained the charges and offered a printout of the charges to R1, but he declined a printout at that time.

LPA requested and received pertinent documents that included a copies of R1 and R2's Admission Service Agreement, Physician's Report, Account History reports, and an itemized list of the last six months' Account History report of Personal Services charges for review. Business Office Manager contacted Corporate office Accounts Receivable to clarify the charges and provided a printout to LPA. LPA reviewed all documents. Documents received from Business Office Manager, did not show an increase in Personal Service Rates during the time period indicated by R1.

Based on observation, interviews, and records review, the allegation of staff are overcharging resident in care and staff do not provide resident with an itemized list of charges, is UNFOUNDED. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

An exit interview was conducted where a copy of this report was reviewed and provided to Celia Saldivar, Business Office Manager.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross	TELEPHONE: 951-248-0314
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023

LIC9099 (FAS) - (06/04)

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