347005391-6-6-2022-25-AS-MSEY-CF6SSR-20220607140822

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005391
Report Date: 06/06/2022
Date Signed: 06/06/2022 01:29:06 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/17/2021 and conducted by Evaluator Kevin Mknelly

COMPLAINT CONTROL NUMBER: 25-AS-20211217151437

FACILITY NAME:	CARE HORIZONS ASSISTED LIVING		FACILITY NUMBER:	347005391
ADMINISTRATOR:	IORDACH-STIR, ADRIANNA		FACILITY TYPE:	740
ADDRESS:	6630 CARE LANE		TELEPHONE:	(916) 721-2073
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	6	CENSUS: 6	DATE:	06/06/2022
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Adriana Iordache- Stir		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Resident is being financially abused at the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on June 6, 2022 to provide complaint findings. LPA met with Adriana and explained the purpose of the visit. Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Upon arrival LPA completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA were screened by facility staff upon entering the facility.

The department reviewed resident records, facility records, bank and police records and conducted interviews.
The department finds that facility met Tittle 22 requirements.

On 12/17/2021, the department received a report that the facility told R1’s payee that the facility has not

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2022

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 25-AS-20211217151437

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: CARE HORIZONS ASSISTED LIVING	FACILITY NUMBER: 347005391
	VISIT DATE: 06/06/2022

NARRATIVE

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been receiving the resident’s monthly rent checks for the last four (4) months. The payee then found out that all the four checks were altered, signed by a different person and were cashed.

The Department subpoenaed records from the banks where checks were cashed for information used and bank surveillance video for the checks being cashed and deposited. The subpoenaed information revealed that: One check dated on 8/25/2021 in amount of $1,079.37 showed the name on the pay line had been changed from Care Horizons an individual’s name P1. On 9/13/2021 at 15:17 p.m. a woman with a tattoo on the front of her chest went to another bank to cash another of the missing checks. P2’s image was captured by bank surveillance. The second check to Care Horizons Assisted Living dated on 11/22/2021 in amount of $1,079.37 showed the name on the pay line has been changed from Care Horizons to P1. On 12/2/2021 at 13:01 p.m. a woman, P1, went to the bank. Her image was captured by bank surveillance and her California identification number was provided. A third check dated on 9/22/2021 in amount of $1,079.37 showed the check was signed by P2 and deposited to P2’s bank account via an ATM in Minnesota on the date of 10/18/2021.

P1 and P2 are not associated with the Care Horizons Assisted Living or any other facility. The telephone interview conducted with residents’ responsible party showed no other residents were affected or financially abused. The allegation that a resident is being financially abused by facility staff is unfounded.

This agency has investigated the above complaint allegations. We have found that the complaint is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

Exit interview conducted and report provided.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin Mknelly	TELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2022

LIC9099 (FAS) - (06/04)

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