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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700554
Report Date: 11/03/2024
Date Signed: 11/03/2024 01:57:45 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/28/2024 and conducted by Evaluator Michael Hood
COMPLAINT CONTROL NUMBER: 59-AS-20240328141731
FACILITY NAME:ANGIES CARE HOMEFACILITY NUMBER:
342700554
ADMINISTRATOR:CRUDO, ANGELINAFACILITY TYPE:
740
ADDRESS:8558 SHERATON DRTELEPHONE:
(916) 962-2460
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:6CENSUS: 6DATE:
11/03/2024
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Angelina Crudo, LicenseeTIME COMPLETED:
02:10 PM
ALLEGATION(S):
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Staff financially abused resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Licensee, Angelina Crudo, to deliver findings into the complaint allegation listed above.

During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

Allegation: Staff financially abused resident

** Report continued on 9099-C **
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2024
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 5
Control Number 59-AS-20240328141731
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ANGIES CARE HOME
FACILITY NUMBER: 342700554
VISIT DATE: 11/03/2024
NARRATIVE
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Relevant party reported that resident (R1) passed away on 5/7/2023 while residing at the facility. Relevant party reported multiple withdrawals occurred from R1’s bank account after R1 passed away during the months of June, July, and August 2023, resulting in withdrawals totaling in the amount of over $20,000. Relevant party stated that no one had access to R1’s bank account and R1 did not have any other payee sources or a power of attorney. The Department obtained a death certificate for R1, which identified that R1 passed away on 5/7/2023 with an immediate cause of death being cardiorespiratory failure. Interview with Licensee confirmed that R1 passed away while residing at the facility. Licensee stated that they had not reported R1’s death to the Department as R1 was on hospice and Licensee was unaware that hospice deaths were to be reported to the Department. Licensee stated that R1 was on hospice for less than a week and was diabetic. Licensee stated that hospice removed R1’s diabetes medication once R1 was placed on hospice. Licensee stated that R1 passed away from natural causes.

Interview with Licensee indicated that they do not have any residents who use Zelle to transfer money to the facility. Licensee stated that they wouldn’t know if they received a Zelle transfer to their account. Licensee stated that most residents pay rent by writing checks to the Licensee. Licensee stated that R1 handled their own money and wrote their own checks. Licensee stated that, when R1 first moved into the facility, R1 gave Licensee a key to their apartment, which contained their cell phone, wallet, driver’s license, television, furniture, and clothing. Licensee stated that they went to R1’s apartment but there was someone else living there already and R1’s key didn’t work. Licensee stated that management at R1’s apartment stated that R1 had been gone for too long and they relinquished R1’s apartment. Licensee stated that they asked for R1’s belongings from the apartment but management stated that they threw out R1’s belongings. Licensee stated that R1 had possession of their checkbook, but checkbook was displaced after R1’s passing. Licensee stated that R1 did not have an ATM card.

Interview with Licensee indicated that, sometimes, R1 would provide Licensee with two (2) or three (3) checks at one time to pay for two (2) or three (3) months in advance. Licensee stated that each check R1 signed to the facility would be for $1,700. Licensee stated that they did not cash any checks from R1 after they passed away, but possibly cashed checks for multiple months in advance. Licensee stated that R1 did not owe any money to Licensee prior to R1 passing away and all money was paid to the facility when R1 passed away.
** Report continued on 9099-C **
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 59-AS-20240328141731
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ANGIES CARE HOME
FACILITY NUMBER: 342700554
VISIT DATE: 11/03/2024
NARRATIVE
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The Department received R1’s Admission Agreement dated 4/22/2022, which indicates that R1 paid privately $5,000 a month using the payment method of “credit/debit, checks, money order, ACH, Online Payment.” The Department received R1’s Physician’s Report LIC 602A (missing date but including exam date of 8/27/2022), which indicates R1 had mild cognitive impairment with confusion.

Licensee stated that they received deposits from Dignity Health that went directly into their business bank account when the residents were clients of Dignity Health. Licensee stated that they sent invoices to Dignity Health for R1’s rent after R1 passed away for one (1) month. Licensee stated that Dignity Health asked for the money back and Licensee refunded the money that was charged for R1. Licensee stated that Dignity Health was charged for the month of June 2023 for R1. Licensee stated that Dignity Health did not owe Licensee money for R1 when they were billed in June 2023, but they owed the Licensee for other residents. Licensee signed a declaration stating “after the passing of [R1] billed the Dignity Health and that money was refunded to them.”

Licensee stated that residents R2 and R6 give the Licensee their ATM cards to withdraw money to pay their rent. Licensee stated that they have the PIN numbers to both R2 and R6’s ATM cards. Licensee stated that they have used their ATM cards to buy them cigarettes in the past. Interview with R2 indicated that they pay rent by having Licensee go to their bank and withdraw the money they owe from their account. R2 stated that Licensee has their PIN number to their ATM card. R2 stated only themselves and the Licensee has their PIN number and no one else. R2 stated that they have no issues or concerns with Licensee regarding their finances or the operation of the facility. R6 could not be interviewed regarding complaint as they passed away on 6/10/2024 during investigation. No other resident interviews expressed concern regarding the facility in relation to financial abuse.

** Report continued on 9099-C **
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 59-AS-20240328141731
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ANGIES CARE HOME
FACILITY NUMBER: 342700554
VISIT DATE: 11/03/2024
NARRATIVE
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The Department obtained bank records for R1’s bank account and observed a Zelle Instant payment made from R1’s bank account directly to “Angelina – MJS Crudo” in the amount of $3,500 on 6/23/2023. Additionally, the Department observed that Licensee signed and cashed two (2) checks from R1’s bank account after R1 passed away. One (1) check dated 6/14/2023 was cashed on 6/21/2023 in the amount of $3,700 from R1’s bank account. Another check dated 6/30/2023 was cashed on 7/7/2023 in the amount of $3,400 from R1’s bank account. The Department obtained bank statements for multiple Wells Fargo accounts owned by Licensee and observed both checks listed above as deposited with the dates and amounts listed above. R1’s bank records show six (6) ATM withdrawals totaling $5515.50 were made after R1 passed away.

Based on interviews conducted, observations, and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D page.

Exit interview was conducted with Licensee. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 59-AS-20240328141731
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ANGIES CARE HOME
FACILITY NUMBER: 342700554
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/04/2024
Section Cited
CCR
87468.2(a)(8)
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (8) To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement is not met as evidenced by:
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Facility will cease handling any resident monies moving forward. Facility will also complete a statement of understanding regarding regulation 87468.2 and submit statement to LPA by POC due date.
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Based on interviews conducted, observations, and records reviewed, the facility did not ensure that resident (R1) was protected from financial exploitation, which poses an immediate health, safety, and personal rights violation to the 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: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5