374604058-1-3-2024-08-AS-LTEZ-CZCVED-20240110152211

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604058
Report Date: 01/03/2024
Date Signed: 01/03/2024 10:57:15 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
12/28/2023 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20231228161104

FACILITY NAME:	NIR COMMUNITY II		FACILITY NUMBER:	374604058
ADMINISTRATOR:	HUQ, RANA		FACILITY TYPE:	740
ADDRESS:	10935 JEFFREY COURT		TELEPHONE:	(858) 348-2017
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92126
CAPACITY:	6	CENSUS: 5	DATE:	01/03/2024
		UNANNOUNCED	TIME BEGAN:	03:45 PM
MET WITH:	Administrator, Faria Huq		TIME COMPLETED:	05:25 PM

ALLEGATION(S):

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Licensee did not refund preadmission fee

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Natasha Persaud conducted a complaint investigation visit. LPA was greeted and allowed entry into the facility by Staff, Zenia Valdehueza. LPA met with Administrator, Faria Huq.

During the investigation, interviews were conducted with staff and outside sources. It was alleged the licensee did not refund the preadmission fee for Resident #1 (R1). On 12/20/23, R1's responsible party had a verbal agreement with the administrator and agreed to move R1 into the facility. On 12/21/23, R1's responsible party issued a check in the amount of $500 for a preadmission fee to hold the room for R1. R1 was awaiting an assessment from the facility, to be admitted. While waiting for the assessment, R1's responsible party changed their mind and decided not to admit R1 to the facility. Title 22 Regulations requires the licensee to provide the applicant or representative with a written general statement describing all costs associated with the preadmission fee. The Administrator confirmed a Preadmission Agreement form was not signed, as there was only a verbal agreement in place. Based on interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California code of Regulations, Title 22, Division 6 & Chapter 8 is being cited on the attached LIC 9099D.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

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-20231228161104

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: NIR COMMUNITY II	FACILITY NUMBER: 374604058
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/03/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/17/2024 Section Cited HSC 1569.651(b)	1 2 3 4 5 6 7	Preadmission fee or deposit for elderly at residential care facilities; written statement describing costs and stating whether fee is refundable; conditions for refund; refund rate schedules. If a licensee charges a preadmission fee, the licensee shall provide the applicant or his or her representative with a written general statement describing all costs associated with the preadmission fee charges and stating that the preadmission fee is refundable. The statement shall describe the conditions for the refund as specified in subdivision (g).	1 2 3 4 5 6 7	Administrator stated she will refund the preadmission fee of $500 by POC due date.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based on interviews, the licensee did not refund a preadmission fee to 1 out of 5 [R1] residents, which posed a potential personal rights risk to residents 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: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

LIC9099 (FAS) - (06/04)

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