336426464-2-2-2023-18-AS-JDHS-D77VZP-20240715165301

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426464
Report Date: 02/02/2023
Date Signed: 02/02/2023 12:08:34 PM

Substantiated

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
11/04/2022 and conducted by Evaluator Stephanie Torres

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20221104103618

FACILITY NAME:	MANZANITA VILLAGE AT RANCHO BELAGO		FACILITY NUMBER:	336426464
ADMINISTRATOR:	EREBHOLO, LATONYA		FACILITY TYPE:	740
ADDRESS:	27900 BRODIAEA AVE.		TELEPHONE:	(800) 870-8066
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92555
CAPACITY:	125	CENSUS: 63	DATE:	02/02/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Kameshi Taylor, Administrator		TIME COMPLETED:	12:10 PM

ALLEGATION(S):

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Residents' rates were raised without proper notification.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Stephanie Torres, conducted an announced visit to the facility to deliver the findings of the investigation into the above allegation. The LPA met with Kameshi Taylor, Executive Director, and informed her of the purpose of her visit.
A report was received indicating residents in care were not provided proper notification for a rate change to be taking place in the following month(s). A record review was conducted; A 30 Day Notice of Rent Increase, dated October 27, 2022, revealed the facility notified residents of a rent change that would go into effect December 01, 2022. ED Taylor was interviewed and confirmed the notice was incorrectly delivered to residents. Based on the facility's Admission Agreement, on page 7, the facility agreed to provide residents with a 60-day notice for any rate increases. Therefore, based on record review and interview, this allegation is deemed SUBSTANTIATED. A finding the complaint is substantiated means the allegation is valid because the preponderance of the evidence standard has been met. A citation will be issued in accordance with the California Code of Regulations (Title 22, Division 6, Chapter 8). An exit interview was conducted; this report was reviewed with ED Taylor and a copy was provided, along with instructions on appeal rights.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Stephanie Torres	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

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-20221104103618

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: MANZANITA VILLAGE AT RANCHO BELAGO	FACILITY NUMBER: 336426464
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/02/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/02/2023 Section Cited CCR 87507(f)	1 2 3 4 5 6 7	ADMISSION AGREEMENTS: (f) The licensee shall comply with all applicable terms & conditions set forth in the admission agreement, including all modifications & attachments. This requirement was not met, as evidenced by: Based on records and interview, the Licensee did not ensure residents were	1 2 3 4 5 6 7	A letter dated December 07, 2022 was sent to residents postponing the increase until March 01, 2023.
	8 9 10 11 12 13 14	given proper notification of a rate increase. A 30-Day Notice of Rent Increase, dated 10/27/22, revealed the facility notified residents of a rent change that would go into effect 12/01/22. ED Taylor confirmed the notice was incorrectly issued. This posed a potential threat to the personal rights of the residents in care.	8 9 10 11 12 13 14
	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: Deborah Mullen	TELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Stephanie Torres	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

LIC9099 (FAS) - (06/04)

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