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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374600799
Report Date: 04/29/2024
Date Signed: 04/29/2024 03:31:36 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, 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
04/26/2024 and conducted by Evaluator Dang Nguyen
COMPLAINT CONTROL NUMBER: 08-AS-20240426131903
FACILITY NAME:CARLSBAD BY THE SEAFACILITY NUMBER:
374600799
ADMINISTRATOR:DIGERNESS, PAULAFACILITY TYPE:
741
ADDRESS:2855 CARLSBAD BLVD.TELEPHONE:
(760) 492-3359
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY:224CENSUS: 201DATE:
04/29/2024
UNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Executive Director Paula Digerness and Executive Assistant Paige KerrTIME COMPLETED:
03:40 PM
ALLEGATION(S):
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Licensee did not timely refund advance fees, as required.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to commence a complaint investigation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Executive Director Paula Digerness and Executive Assistant Paige Kerr.

The Complianant alleged that after Resident #1 (R1) passed away, Licensee did not timely refund rent monies which R1 previously paid in advance, and which were now due to R1’s estate. CCLD’s investigation involved an unannounced facility tour, review of pertinent billing, care, and administrative records and E-mails, and interviews of relevant facility staff and outside sources.

Interviews and records unanimously showed: R1’s responsible person (RP) signed R1’s admissions agreement when R1 first moved into the facility in 2020. On 03/04/2024, R1 passed away at the facility under hospice care. On 03/05/2024, RP vacated R1’s room of personal belongings and relinquished R1’s room to facility management. [CONTINUED ON LIC 9099-C]
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024
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 3
Control Number 08-AS-20240426131903
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: CARLSBAD BY THE SEA
FACILITY NUMBER: 374600799
VISIT DATE: 04/29/2024
NARRATIVE
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[CONTINUED FROM LIC 9099] Before R1 died, they had prepaid their rent through 03/31/2024. The dollar amount of R1’s March 2024 rent, which they prepaid but did not fully use/expend, is not currently under dispute by any party.

According to facility manager interviews and E-mails: As of the commencement of CCLD’s investigation on 04/29/2024, R1’s refund had not yet been disbursed to either R1’s estate or RP, due to outstanding/unpaid balance which R1 had previously incurred at Licensee’s skilled nursing facility (SNF). However, R1’s admissions agreement together with facility billing records showed that the final amount which Licensee charged (and which R1 paid before they died) was expressly for R1’s March 2024 assisted living stay, and not for skilled nursing / healthcare fees.

Per regulation, Licensee was required to issue/disburse the refund to R1’s estate within 15 days of their bedroom being vacated of belongings, irrespective of whatever separate business R1 had with Licensee’s SNF facility. Interviews and records aligned to show that this requirement was not met.

Based on records and interviews, a preponderance of evidence exists to show that Licensee did not timely refund advance fees, as required. One (1) deficiency was cited per California Health and Safety Code (refer to the attached LIC 9099-D). A Plan of Correction was jointly developed with the Licensee.

An exit interview was conducted with Digerness and Kerr, to whom a copy of this report, the LIC 9099-D, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20240426131903
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: CARLSBAD BY THE SEA
FACILITY NUMBER: 374600799
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/03/2024
Section Cited
HSC
1569.652
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1569.652 Termination of Admission agreement upon death of resident, etc.: “(c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees, or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the property is removed.”
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Licensee agreed to immediately issue a check (either electronic or paper) for $7,626.25. This payment may be made to either R1’s estate or to RP (depending on Licensee’s internal process requirements). Licensee agreed to E-mail proof of payment disbursement to LPA, by the POC due date.
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This requirement was not met, as evidenced by: Based on records and interviews, for 1 of 201 residents (R1), Licensee did not refund fees paid in advance, covering the time after R1 died and their personal property was removed from the facility, to R1’s estate within 15 days. This posed a potential personal rights violation 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.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3