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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604215
Report Date: 02/27/2023
Date Signed: 02/27/2023 01:41:12 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
02/22/2023 and conducted by Evaluator Marisela Garcia-Centeno
COMPLAINT CONTROL NUMBER: 08-AS-20230222141308
FACILITY NAME:VILLA FLORENZAFACILITY NUMBER:
374604215
ADMINISTRATOR:ALVI, ZOHAIBFACILITY TYPE:
740
ADDRESS:5171 ALAMOSA PARK DRIVETELEPHONE:
(480) 326-6082
CITY:OCEANSIDESTATE: CAZIP CODE:
92054
CAPACITY:6CENSUS: 5DATE:
02/27/2023
UNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Administrator, Zohaib AlviTIME COMPLETED:
01:40 PM
ALLEGATION(S):
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Facility did not issue resident a full refund
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced complaint investigation visit to open and investigation and to deliver findings on the above allegation. LPA was granted entry by Caregiver, Marjon Saberdo LPA discussed the purpose of the visit and the basic elements of the allegation mentioned above with Administrator, Zohaib Alvi.

The Department investigated the above listed complaint allegation. The investigation consisted, consisted of review of facility records, and interviews with facility staff, and outside sources.

On February 22, 2023, Community Care Licensing (CCL) received a complaint alleging that facility did not refund money owed after resident’s death, specifically that a resident (R1), [an LIC 811 Confidential Names List was provided to staff to identify the Resident], did not get a full refund.

(Continue on LIC812C)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-CentenoTELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2023
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-20230222141308
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: VILLA FLORENZA
FACILITY NUMBER: 374604215
VISIT DATE: 02/27/2023
NARRATIVE
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(Continue from LIC812)

Review of R1’s signed Admission Agreement indicated that R1 moved into the facility on August 7, 2022. On September 5, 2022, R1 passed away and R1’s personal belongings were subsequently removed from the facility on September 6, 2022. Outside sources and staff confirmed R1’s personal belongings were taken out of R1’s room on September 6, 2022. On September 1, 2022, R1’s Power of Attorney (POA) paid the full rate of $6,000 for the month of September 2022. On October 1, 2022, staff reimbursed R1’s POA 50% of the monthly rate or $3,000. Review of the Admissions Agreement indicated the facility’s policy for reimbursement was stated as, “in the event, where/if resident expires before the 10th of the month, POA will only receive the refund for the second half of the month. The resident dies on or after the 10th of the month, there will be no refund applicable in that case”. However, according to Title 22 regulations, admission agreements shall not contain any provision that violates the rights of any residents including refund of fees paid. Specifically, according regulations, a refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to R1’s POA, within 15 days after the personal property is removed. Based on review of records, and interviews with staff and outside sources, R1’s was entitled for a full reimbursement of $4,800. In addition, records review indicated that Licensee did not reimburse R1 the reimbursement within 15 days after R1's personal belongings were removed. Therefore, this allegation is substantiated, as there is a preponderance of evidence to show the violation occurred. Pursuant to the California Code of Regulations, Title 22, Division 6, deficiency is being cited on the attached LIC9099D and a plan of correction was jointly developed with Administrator.

An exit interview was conducted; a copy of this report, LIC811 and Licensee's Rights (LIC9058) were provided to Administrator, Zohaib Alvi.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-CentenoTELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 08-AS-20230222141308
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: VILLA FLORENZA
FACILITY NUMBER: 374604215
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/06/2023
Section Cited
HSC
1569.652
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1569.652(c) Termination of admission agreement upon death of resident,... refund of fees paid.... A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the POA, ... within 15 days after the personal property is removed. This requirement is not met as evidenced by:
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Licensee agreed to refund the sum of $1,800 to R1's POA; certified mail receipt and copy of cashier's check will be sent to LPA as proof by POC date of 3/6/2023.
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Based on interviews and record review, the licensee did not provide full reimbursement to 1 of 5, which posed a personal rights risk to 1 of x residents in care.
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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: Marisela Garcia-CentenoTELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3