374603509-3-27-2024-08-AS-SJAB-D3STAG-20240328143332

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603509
Report Date: 03/27/2024
Date Signed: 03/27/2024 01:11:24 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
01/12/2024 and conducted by Evaluator Alyssa Ramirez

COMPLAINT CONTROL NUMBER: 08-AS-20240112134103

FACILITY NAME:	WESTMONT AT SAN MIGUEL RANCH		FACILITY NUMBER:	374603509
ADMINISTRATOR:	MICHAEL SOKOLOWSKI		FACILITY TYPE:	740
ADDRESS:	2325 PROCTOR VALLEY RD		TELEPHONE:	(619) 271-4385
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91914
CAPACITY:	105	CENSUS: 66	DATE:	03/27/2024
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Resident Services Director Eva Amorim		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff did not communicate with responsible party of fee increases for resident's care plan.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alyssa Ramirez conducted an unannounced complaint visit to deliver findings on the above allegations. LPA met with Resident Services Director Eva Amorim and discussed the purpose of the visit and elements of the complaint.

Community Care Licensing (CCL) has investigated the above allegations. The investigation consisted of records review, interviews with facility staff, clients and outside agency.

It was reported to CCL that staff did not communicate with responsible party of fee increases for resident’s care plan.

[Continued on 9099-C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Alyssa Ramirez	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024

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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Control Number 08-AS-20240112134103

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: WESTMONT AT SAN MIGUEL RANCH	FACILITY NUMBER: 374603509
	VISIT DATE: 03/27/2024

NARRATIVE

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[Continued from 9099]

Regarding allegation, “staff did not communicate with responsible party of fee increases for resident’s care plan”, it was alleged that the facility increased cost in care level for R1 without having a meeting with responsible party. Interviews with facility staff revealed that they do not schedule a meeting every time there is a change in care level pricing. Review of admission’s agreement had no mention of required meetings when changes in care level costs. Admission’s agreement section “Change in Services” states “If Westmont at San Miguel Ranch determines through an assessment, that you require additional services or a different care program than the one in which you are participating , you agree to the new additional services or care program appropriate to your needs. The rate for the new service or care program shall apply immediately. The community will give you written notice of a care change and corresponding rate increase within two (2) business days after providing newly assessed services.” Interview’s with outside sources revealed that R1’s responsible party did not receive notification of increase in care level cost. Facility provided LPA documentation showing that changes to service plan was emailed to R1’s responsible party on 12/20/2023. Review of records revealed that R1 required more assistance with ADL’s on updated assessment dated 12/20/2023. Interview’s with outside sources revealed that R1 did require more assistance with ADL’s since the last assessment that was conducted in 6/9/2023.

Based upon the foregoing, the above listed allegations are unsubstantiated. This finding means that the preponderance of the evidence standard has not been met and the allegations are not valid. No deficiencies were cited today.

An exit interview was conducted with Resident Services Director Eva Amorim . A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to Resident Services Director Eva Amorim whose signature below verifies receipt of these rights.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Alyssa Ramirez	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024

LIC9099 (FAS) - (06/04)

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