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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701229
Report Date: 04/24/2024
Date Signed: 04/30/2024 03:14:54 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
09/11/2023 and conducted by Evaluator Christina Valerio
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230911131450
FACILITY NAME:SERRANO GUEST HOME 3FACILITY NUMBER:
342701229
ADMINISTRATOR:MEZA, LILIBETHFACILITY TYPE:
740
ADDRESS:8667 SUMERLIN CT.TELEPHONE:
(916) 661-2940
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:6CENSUS: 5DATE:
04/24/2024
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Lilbeth MezaTIME COMPLETED:
04:20 PM
ALLEGATION(S):
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Licensee is financially abusing resident in care.
INVESTIGATION FINDINGS:
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Sacramento South Regional Office held an office meeting via Microsoft teams on 04/24/24 at 3:00 PM. The purpose of the meeting was to discuss Trust Audit Report Findings. Present in today's meeting were Regional Manager (RM) Stephenie Doub, Licensing Program Manager (LPM) Stephen Richardson, Licensing Program Analyst (LPA) Christina Valerio, Gereral Auditor (GM) Xiao Ni, and Licensee/Administrator Lilibeth Meza

The following was discussed as it relates to the following allegation: Licensee is financially abusing resident in care. The investigation consisted of interview with the licensee/administrator, interview with residents, facility records review, and external records review.

Based on records review of facility records, it was learned that Resident 1 (R1) resided in three
different facilities, all owned by the same licensee, during the past few years.
Continues on LIC 9099 - C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024
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 4
Control Number 27-AS-20230911131450
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SERRANO GUEST HOME 3
FACILITY NUMBER: 342701229
VISIT DATE: 04/24/2024
NARRATIVE
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Continued from LIC 9099

R1 moved to Serrano Guest Home 3 on 01/07/2023. The monthly basic service rate was $4,000 per month per Admission Agreement. R1’s Physician Appraisal Report dated on 09/07/2023 was reviewed and identified that R1 was diagnosed with mild cognitive impairment and unable to independently transfer to and from bed.
R1 Bank Records were reviewed. The following was learned: On 06/08/2022, R1 told bank staff that her care provider named Lilibeth Meza forced her to withdrawal funds in branch. On 03/14/2023, the bank received a call, but it was hard to tell who was calling. It was very confusing in the beginning R1 seemed confused and did not know the passcode and needed to lay down. The caregiver came to branch and tried to cash a large check on the same day. On 09/05/2023, caregiver continues to be seen using R1’s debit card. On 11/03/2023, a suspicious voice was heard in the background coaching R1 to make transfers. When bank staff asked if R1 really wanted to make a transfer. The telephone line started cutting out and no longer make out R1’s response.

In March 2023, R1’s New York Life Insurance payment check $18,656.63 was mailed to Serrano Guest Home 2 (8774 Kelsey Dr. Elk Grove, CA 95624). On 3/9/2023 at 15:20 PM. licensee deposited R1’s New York Life Insurance payment check at Golden One Credit Union ATM machine located at Elk Grove, CA. Her image was captured by bank’s surveillance. The next day, R1’s check dated on 3/10/2023 was made out to Lilibeth Meza for $16,753. On 3/20/2023, this check was cleared. In addition, there were two checks made out to Lilibeth Meza for totaling $19,153 in the month of March 2023. The amount paid to licensee did not match with R1’s monthly rent $4,000.

Based on R1’s bank accounts activities and transactions review, the check amount paid to the licensee did not match with R1’s rent stated on the admission agreement. The auditor compared the total amount withdrawals for the period from October 2019 to the October 2023 to the total amount rent should be charged, for the same period. A variance of $17,539.31 was noted. (Total Withdrawals $212,339.31 – Total Rent Amount $194,800).

Continues on LIC 9099 -C, page 3
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 27-AS-20230911131450
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SERRANO GUEST HOME 3
FACILITY NUMBER: 342701229
VISIT DATE: 04/24/2024
NARRATIVE
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Continues from Page 2, LIC 9099 - C

According to an interview with Licensee Lilibeth Meza, The licensee claimed that she did not handle R1’s cash resources, but she assisted R1 to make rent payments.

Based on documenting and information available, the allegation of licensee financially abused R1 is substantiated.

Per California Code of Regulations (CCR) - Title 22, Division 6, Chapter 8, deficiencies are being cited on the attached LIC 9099 - D page. Failure to correct deficiencies may result in civil penalties.

An exit interview was held with Licensee/Administrator Lilibeth Meza, and a copy of the report was provided. Administrator Lilibeth had no further questions and stated she would sign the reports and send back to LPA Valerio.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Citations on this Visit Report are Under Appeal!

Control Number 27-AS-20230911131450
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: SERRANO GUEST HOME 3
FACILITY NUMBER: 342701229
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
05/01/2024
Section Cited
CCR
87468.2(a)(8)
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87468.2 Additional personal rights of
residents(a) In addition to the rights listed in Section 87468.1...,residents...shall have all of the following personal rights: (8) To be free from neglect, financial exploitation... This requirement was not met as evidenced by:
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Licensee is to pay R1 the overcharge of $17,539.31. Licensee is to send a plan that provides details and proof of payment to R1 by POC due date. Licensee to submit a statement regarding Cash Handling, Bonding, and Safeguarding of Resident Funds
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Based on records review and interviews, the licensee did not ensure R1's money properly handled, which resulted in R1 being overcharged by $17,539.31. This poses an immediate health, safety, and personal rights risk to 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: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4