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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602806
Report Date: 05/27/2021
Date Signed: 05/27/2021 03:03:44 PM



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
05/18/2021 and conducted by Evaluator Lizzette Tellez
COMPLAINT CONTROL NUMBER: 08-AS-20210518092906
FACILITY NAME:HOME SWEET HOME CAREFACILITY NUMBER:
374602806
ADMINISTRATOR:NONAY, NORMA D.FACILITY TYPE:
740
ADDRESS:6811 FUJI STREETTELEPHONE:
(619) 472-9205
CITY:SAN DIEGOSTATE: CAZIP CODE:
92139
CAPACITY:6CENSUS: 3DATE:
05/27/2021
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Licensee/Administrator, Norma NonayTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Licensee failing to abide by admission agreement
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Lizzette Tellez conducted an unannounced complaint visit to deliver findings on the above-mentioned allegation. LPA was met by Norma Nonay, Licensee/Administrator, and was allowed entry into the facility. LPA met with Ms. Nonay and discussed the purpose of the visit.

The Department's investigation consisted of interviews with staff, residents, review of records, and a brief tour of the facility. It was alleged that the Licensee is failing to abide by the admission agreement for Resident #1 (R1). Ms. Nonay was provided with Confidential Names Form in order to identify R1. Investigation revealed that R1 was admitted to the facility on October 13, 2011, and entered into an admission agreement with a specified, fixed amount as the monthly rate. R1's finances are managed by their placement agency. Interviews with staff and review of records revealed that on April 27, 2021, Administrator Nonay provided the placement agency and resident with a written notice to increase the monthly rate due to increased cost of living, which had an effective date of May 1, 2021. Although written notice was provided, 60 days notice was not given as required by Health and Safety Code.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Lizzette TellezTELEPHONE: (619) 219-9755
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021
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-20210518092906
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: HOME SWEET HOME CARE
FACILITY NUMBER: 374602806
VISIT DATE: 05/27/2021
NARRATIVE
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The Department has investigated the allegation that the Licensee failed to abide by the admission agreement and has found that, based upon interviews and record review, the preponderance of the evidence standard has been met. Therefore, this allegation is deemed substantiated.

This deficiency is noted on the attached 9099-D, and is cited in accordance with the California Code of Regulations, Title 22. An exit interview was conducted with Ms. Nonay and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to the Administrator via electronic mail. An electronic receipt of confirmation was requested to be sent by the Administrator upon receipt of the documents.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Lizzette TellezTELEPHONE: (619) 219-9755
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20210518092906
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: HOME SWEET HOME CARE
FACILITY NUMBER: 374602806
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/27/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/03/2021
Section Cited
HSC
1569.655
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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...
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Licensee stated the notice to increase the rate was rescinded. Licensee stated a written copy of the notice to rescind will be provided to CCL by POC due date.
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This requirement was not met as evidenced by:
Based on record review and interviews, the Licensee did not provide R1 and their representative with a 60 days' written notice to increase the monthly rate due to increased cost of living. This poses a potential personal rights risk to R1.
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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: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Lizzette TellezTELEPHONE: (619) 219-9755
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3