374604177-1-25-2023-08-AS-SJAB-CNLQ8R-20230131105709

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604177
Report Date: 01/25/2023
Date Signed: 01/25/2023 11:18:38 AM

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
11/08/2021 and conducted by Evaluator Elizabeth Hamilton

COMPLAINT CONTROL NUMBER: 08-AS-20211108122818

FACILITY NAME:	ATRIA BONITA		FACILITY NUMBER:	374604177
ADMINISTRATOR:	WILLIAMS, REBECCA		FACILITY TYPE:	740
ADDRESS:	3434 BONITA ROAD		TELEPHONE:	(619) 476-9444
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91910
CAPACITY:	145	CENSUS:	DATE:	01/25/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Business Office Director, Rebecca Toves		TIME COMPLETED:	09:30 AM

ALLEGATION(S):

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Licensee did not issue refund

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Hamilton conducted an unannounced complaint investigation visit at the facility. LPA gained access to the facility, met with Business Services Director, Rebecca Toves and explained the purpose of the visit which was to deliver findings for the above allegation.

The Department’s investigation consisted of record reviews, interviews with staff and outside sources.

On November 08, 2021, it was alleged that Licensee did not issue a refund after a resident moved out of the facility. Records reviewed confirmed Resident 1’s (R1 – See LIC 811 Confidential Names List) responsible party paid in advance for services for the month of July 2021, in the amount of $4916.00. Records further confirmed R1 was voluntarily relocated from facility on July 17, 2021.

This is an amended report.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth Hamilton	TELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

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-20211108122818

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: ATRIA BONITA	FACILITY NUMBER: 374604177
	VISIT DATE: 01/25/2023

NARRATIVE

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Interviews with outside sources determined a partial refund was provided; however, it was not until approximately four months later. Facility documentation corroborated the refund was issued.

The Department has investigated the allegation of Licensee did not issue a refund. Based on evidence obtained, the allegation is substantiated which means that the allegation is valid because the preponderance of the evidence standard has been met. A deficiency is cited in accordance of California Code of Regulations, Title 22, Division 6 Chapter 8, and listed on the 9099D.

An exit interview was conducted with Business Services Director, Toves a copy of this report, confidential names list, LIC 9099D and Licensee/Appeals Rights (LIC 9058 01/16) was provided.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth Hamilton	TELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20211108122818

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: ATRIA BONITA	FACILITY NUMBER: 374604177
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/25/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/25/2023 Section Cited CCR 87507	1 2 3 4 5 6 7	87507 Admission Agreements (f) The licensee shall comply with all applicable terms and conditions set forth in the admission agreement. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee provided a refund to the responsible party in November 2021. POC cleared.
	8 9 10 11 12 13 14	Based on interviews and record reviews the licensee did not issue a refund to the responsible party within 21 days after R1’s personal property was removed. This posed a potential personal rights risk to one out of ninety nine 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: Elizabeth Hamilton	TELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

LIC9099 (FAS) - (06/04)

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