336423521-10-27-2023-56-AS-EMAN-CXKVCC-20231114151855

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336423521
Report Date: 10/27/2023
Date Signed: 10/27/2023 11:42:37 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
06/27/2023 and conducted by Evaluator Mary Rico

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230627095436

FACILITY NAME:	ABBEY ELDER CARE, INC.		FACILITY NUMBER:	336423521
ADMINISTRATOR:	SUNDEEP RANDHAWA		FACILITY TYPE:	740
ADDRESS:	3412 WEXFORD CIRCLE		TELEPHONE:	(951) 858-8641
CITY:	CORONA	STATE: CA	ZIP CODE:	92882
CAPACITY:	6	CENSUS: 5	DATE:	10/27/2023
		UNANNOUNCED	TIME BEGAN:	09:07 AM
MET WITH:	Claudia Pinon		TIME COMPLETED:	11:50 AM

ALLEGATION(S):

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Facility staff did not issue a refund.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to deliver findings on the allegation listed above. LPA met with Claudia Pinoni and explained the purpose of the visit. The investigation consisted of staff interviews and a record review.

For allegation, Facility staff did not issue a refund.

During staff interviews, Administrator informed LPA that R1 passed away on 6/20/2023 and R1’s family had removed belongs from the facility on 6/21/2023. R1’s family made a payment of 3,475.00 for June 2023. In addition, Licensee provided reimburstment of an amount of 135.83 to R1's family.

During record review, Facility did not issue a complete reimbursement. R1’s family should receive the correct reimburstment. The reimburstment is calculated after resident’s personal property has been removed from the facility from 6/22/2023 through 6/30/2023 without additional late fees.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary Rico	TELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023

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 56-AS-20230627095436

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ABBEY ELDER CARE, INC.	FACILITY NUMBER: 336423521
	VISIT DATE: 10/27/2023

NARRATIVE

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Furthermore, during record review LPA noted that Licensee issued additional late fees for R1 for the year 2021 which carried over to 2022 and 2023. For the years 2021,2022 and 2023 the Licensee increase rates but provide written notice less than 60 days. Licensee provided a written notice less than 60 days.

Based on the evidence gathered during today’s investigation, the one (1) allegation listed above are deemed SUBSTANTIATED. A finding that the complaints are SUBSTANTIATED means that the allegations are valid because of the preponderance of evidence the standard has been met.

During today’s visit, one (1) deficiency was cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC9099) and LIC9099D were discussed and provided to ************, along with a copy of the appeal rights.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary Rico	TELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 56-AS-20230627095436

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ABBEY ELDER CARE, INC.	FACILITY NUMBER: 336423521
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/27/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/03/2023 Section Cited HSC 1569.652(c)	1 2 3 4 5 6 7	1569.652(c) Termination of admission agreement upon death of resident; removal of resident’s property; refund of fees paid.. and refund(c)A refund of any fees paid in advance ..removed from the.. deceased resident paid the fees,.. within 15 days .. personal property is ..	1 2 3 4 5 6 7	Licensee will provide LPA proof that they provided R1's family correct reimbursement. And proof they have read and understood regulation.
	8 9 10 11 12 13 14	Based on interview and record review, the licensee did not comply with the section cited above by not providing correct reimburstment which poses a potential health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14	POC due date 11/3/2023
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary Rico	TELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023

LIC9099 (FAS) - (06/04)

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