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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374600488
Report Date: 03/07/2024
Date Signed: 03/08/2024 08:28:23 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/15/2023 and conducted by Evaluator Jennifer Walden
COMPLAINT CONTROL NUMBER: 08-AS-20231115144424
FACILITY NAME:CASA DE LAS CAMPANASFACILITY NUMBER:
374600488
ADMINISTRATOR:KIMBERLY FINCH-DOMINYFACILITY TYPE:
741
ADDRESS:18655 WEST BERNARDO DRIVETELEPHONE:
(858) 451-9152
CITY:SAN DIEGOSTATE: CAZIP CODE:
92127
CAPACITY:582CENSUS: DATE:
03/07/2024
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Kim DominyTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Provider made material representation about accepted heathcare and changes to the Continuing Care Contracts that were not previously approved by residents or the Continuing Care Contracts Bureau
INVESTIGATION FINDINGS:
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Complainant alleges that the Provider made material misrepresentation about accepted healthcare and changes were made to the Continuing Care Contracts that were not previously approved by residents or the Continuing Care Contracts Bureau.

The Department interviewed complainant and Kim Dominy, Executive Director and reviewed the Continuing Care Contract, Quick Guide: Insurance for Health Center Stays and documentation that was provided to Casa residents regarding Medicare vs Medicare Advantage HMOs.

The continuing care contract required residents to “enroll at your own expense in Medicare (Parts A and B)”. Furthermore, the contract states “If you choose HMO coverage rather than Medicare, Casa reserves the right to charge you market rates for any services you receive”. On September 22, 2023, Provider provided a Quick Guide which included a list of approved insurers and insurance companies that will no longer be contracted with Casa effective January 1, 2024. The document clarifying coverage does not constitute a change of the contract. Sections IV(F) and (J) of the Casa Contract provide that Casa de las Campanas is able to be paid for its services by Medicare or from a third party on similar terms and at the same rate, requiring residents to obtain Medicare Parts A and B or the equivalent. Thus the Casa Contract properly reserved for the provider the right to reject Medicare Advantage HMO type polices.

Based on the review and investigation the Department finds the allegation “unsubstantiated”.

Complaint finding were delivered telephonically and LIC 9099 was signed and emailed.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Allison NakatomiTELEPHONE: (916) 531-5336
LICENSING EVALUATOR NAME: Jennifer WaldenTELEPHONE: (916) 651-8148
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
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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