366413072-12-1-2023-56-AS-NBRN-CYXTT3-20231228140005

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366413072
Report Date: 12/01/2023
Date Signed: 12/01/2023 03:01:36 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
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/29/2023 and conducted by Evaluator Anna Bueno

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20231129144025

FACILITY NAME:	VILLAS AT SAN BERNARDINO		FACILITY NUMBER:	366413072
ADMINISTRATOR:	YVETTE NAVARRO		FACILITY TYPE:	740
ADDRESS:	2985 NORTH G STREET		TELEPHONE:	(909) 883-7703
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92405
CAPACITY:	97	CENSUS: 94	DATE:	12/01/2023
		UNANNOUNCED	TIME BEGAN:	11:04 AM
MET WITH:	Kenya Carlton - Executive Director		TIME COMPLETED:	03:05 PM

ALLEGATION(S):

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Licensee evicted resident without sufficient cause.
Licensee did not provide adequate notice of fee increase to resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the facility to initiate the complaint investigation and deliver findings on the above allegations. LPA met with executive director and administrator Kenya Carlton who was informed of the purpose of today’s visit. The investigation consisted of interviews with relevant parties, and review of relevant records.

It is alleged that Licensee evicted Resident (R1) without sufficient cause and that Licensee did not provide adequate notice of fee increase to R1. LPA reviewed R1's admission agreement and notices issued to R1's responsible party, including an eviction and a rent increase. LPA found that the reason for eviction listed on the notice is not in the admission agreement. LPA found that the notice was issued on the same day of the effective date of the rent increase.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna Bueno	TELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023

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-20231129144025

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
, CA 92507

FACILITY NAME: VILLAS AT SAN BERNARDINO	FACILITY NUMBER: 366413072
	VISIT DATE: 12/01/2023

NARRATIVE

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Based on the above information, this allegation is substantiated. This poses an immediate health and safety risk to residents in care. A finding that the complaint is SUBSTANTIATED means that the allegations are valid as the preponderance of the evidence standard has been met.

Refer to LIC809-D for deficiencies cited. Technical advisory and technical violation were issued for other concerns discovered during today's visit. An exit interview was conducted where this report, LIC809-D, and appeal rights were discussed with and provided to Administrator Carlton.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna Bueno	TELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 56-AS-20231129144025

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
, CA 92507

FACILITY NAME: VILLAS AT SAN BERNARDINO	FACILITY NUMBER: 366413072
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/01/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 12/04/2023 Section Cited CCR 87224(a)(5)(A)(1)	1 2 3 4 5 6 7	(5) Change of use of the facility. (A) Licensee may, upon no less than 60 days written notice, evict a resident due to change of use... 1. In addition to written notice to quit requirements specified in Section 87224(d), written notice to evict...shall be made to resident or their responsible person and shall include all requirements specified in Section 1569.682(a)(2)(A) through (F) of the Health and Safety Code.	1 2 3 4 5 6 7	Licensee shall R1's responsible party a notice stating that the initial eviction notice is null and void. Licensee shall comply with the POC no later end of POC date.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Per records reviewed by LPA, the reason for eviction referenced on the notice does not exist is the admission agreement signed by R1's responsible party. This poses an immediate health and safety risk to clients in care.	8 9 10 11 12 13 14	Licensee sent an updated notice to R1's responsible party during today's visit. This POC has been satisfied as of today's visit.
	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: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna Bueno	TELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 56-AS-20231129144025

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
, CA 92507

FACILITY NAME: VILLAS AT SAN BERNARDINO	FACILITY NUMBER: 366413072
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/01/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/15/2023 Section Cited HSC 1569.655(a)	1 2 3 4 5 6 7	(a) If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 60 days' prior written notice to the residents or the residents' representatives setting forth the amount of the increase, the reason for the increase, and a general description of the additional costs, except for an increase in the rate due to a change in the level of care of the resident. This subdivision shall not apply to optional services that are provided by individuals, professionals, or organizations under a separate fee-for-service arrangement with residents.	1 2 3 4 5 6 7	Licensee shall provide an in-service regulation training to all staff involved with resident billing services. Licensee shall submit proof of correction no later than end of POC date.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Per records reviewed by LPA, R1's rent increase notice was issued on the same day as the effective date of the rent increase. This poses a potential health and safety risk to clients 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: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna Bueno	TELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4