374604176-9-7-2021-08-AS-DPOL-C7CVN8-20210930163442

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604176
Report Date: 09/07/2021
Date Signed: 09/07/2021 04:18:28 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
08/31/2021 and conducted by Evaluator Adam Hamer

COMPLAINT CONTROL NUMBER: 08-AS-20210831095657

FACILITY NAME:	ALTA VISTA SENIOR LIVING		FACILITY NUMBER:	374604176
ADMINISTRATOR:	ALSPACH, DAVID		FACILITY TYPE:	740
ADDRESS:	2041 W VISTA WAY		TELEPHONE:	(760) 941-3233
CITY:	VISTA	STATE: CA	ZIP CODE:	92083
CAPACITY:	98	CENSUS: 76	DATE:	09/07/2021
		UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Diane Domingo, Administrator		TIME COMPLETED:	12:10 PM

ALLEGATION(S):

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Facility did not issue resident a timely refund.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Adam Hamer conducted an unannounced complaint investigation visit on today’s date. LPA identified himself at the front entrance and disclosed the purpose of the visit, which was to conduct a complaint investigation and deliver the finding for the above allegation. Administrator Diane Domingo then met with LPA and provided him with requested facility records.

The Department’s investigation included interviews with Administrator Diane Domingo and outside sources. Facility records were also obtained by the Department and reviewed for pertinent evidence.

The Department received a complaint on August 31, 2021 alleging that the facility did not issue resident a timely refund. Interviews with Ms. Domingo and with outside sources revealed that resident #1 (R1)(See Confidential Names List - LIC 811) was a resident at the facility and their legally responsible person signed an admission agreement on March 31, 2021. Therefter, on April 27, 2021, R1 gave the facility a thirty (30)-day written notice that they would be leaving the facility on May 26, 2021. R1 was then due a refund for the remainder of the "community fee" that they had paid upon admission. The facility still has not issued this refund to R1.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Adam Hamer	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

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-20210831095657

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: ALTA VISTA SENIOR LIVING	FACILITY NUMBER: 374604176
	VISIT DATE: 09/07/2021

NARRATIVE

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A records review also revealed that R1's legally responsible person signed the admission agreement on March 31, 2021, and that R1 would begin their residency at the facility on April 1, 2021. Facility records also revealed that R1 gave the facility a thirty (30)-day written notice on April 21, 2021 that they would be moving out of the facility by May 26, 2021, and that R1 did, in fact, move out by that date. R1 then requested a refund of the remaining portion of the community fee on at least two occasions, the last one in writing on August 5, 2021. The admission agreement signed by the facility representative and R1's legal representative states that, "You will receive any refund that is due within thirty (30) days following the effective termination date." Records reveal and the Administrator concedes that the effective termination date of R1's residency was May 26, 2021. Therefore, a refund of sixty (60) percent of the community fee, less $500 was due to R1 within thirty (30) days of May 26, 2021. To this day, which is well beyond the thirty days required under the agreement, R1 still has not received their refund.

Based on the evidence obtained from interviews and records review, the allegation that facility did not issue resident a timely refund is found to be SUBSTANTIATED, as there is a preponderance of the evidence to prove that the allegation occurred. A citation is being issued in accordance with California Code of Regulations, Title 22, and is listed on the attached LIC 9099D, as is the plan of correction that was developed by Administrator Diane Domingo.

An exit interview was conducted with Ms. Domingo, and a copy of this report, the LIC 9099D, the LIC 811 and Licensee/Appeal Rights (LIC 9058 FAS 01/16) were emailed to her to the email address that she provided to LPA; she expressed that she would send a confirmation email upon receipt of these documents.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Adam Hamer	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20210831095657

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: ALTA VISTA SENIOR LIVING	FACILITY NUMBER: 374604176
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/07/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/20/2021 Section Cited CCR 87507(g)(3)(5)(E)...	1 2 3 4 5 6 7	87507. Admission Agreements. (g) Admission agreements shall specify the following: (3) Payment provisions, including...: (5) Refund conditions. (E) Preadmission fees shall be refunded according to the following conditions:	1 2 3 4 5 6 7	Adminstrator will ensure that R1 receives a full refund of all moneys due by September 20, 2021, and show proof to LPA by that date.
	8 9 10 11 12 13 14	2. ...paid preadmission fees that are greater than five hundred dollars ($500) shall be refunded to...resident, or the...resident's representative in the following manner: b. A refund of at least 60 percent of the preadmission fee in excess of $500 shall be provided if the resident leaves the facility for any reason during the second month of residency. This requirement was not met as evidenced by: Based on records review and interviews, facility did not issue a timely refund to resident which poses a personal rights risk to 1 out of 76 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: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Adam Hamer	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

LIC9099 (FAS) - (06/04)

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