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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604294
Report Date: 01/04/2024
Date Signed: 01/04/2024 11:53:43 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/28/2023 and conducted by Evaluator Janette Romero
COMPLAINT CONTROL NUMBER: 18-AS-20230728094657
FACILITY NAME:LAS VILLAS DEL NORTEFACILITY NUMBER:
374604294
ADMINISTRATOR:FARISH, JOLENEFACILITY TYPE:
740
ADDRESS:1325 LAS VILLAS WAYTELEPHONE:
(760) 741-1047
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY:198CENSUS: 155DATE:
01/04/2024
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Administrator, Jolene FarishTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff overcharged resident for care
INVESTIGATION FINDINGS:
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On 1/4/2024, Licensing Program Analyst (LPA) Janette Romero conducted an unannounced complaint visit to deliver amended findings regarding the allegation listed above. LPA met with Administrator Jolene Farish.

Regarding the allegation of “Staff overcharged resident for care” it was alleged that Resident 1 (R1) was over charged for monthly care fees after the resident was absent from the facility for over fourteen days due to hospitalization. LPA reviewed R1’s Admission Agreement and found that on page 13, subsection 6, titled, “Absences” stated, “If you are absent from LAS VILLAS DEL NORTE for more than fourteen (14) consecutive days, you will receive a pro-rated credit toward your Monthly Care Fee starting on day fifteen (15).”

*This is an amended version of the original report.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (951) 248-0350
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023
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 18-AS-20230728094657
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: LAS VILLAS DEL NORTE
FACILITY NUMBER: 374604294
VISIT DATE: 01/04/2024
NARRATIVE
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This confirms the facility is to issue a pro-rated credit towards R1’s monthly care fees if the resident was absent from the facility for more than fourteen consecutive days.

R1 was absent from the facility on April 17, 2023 – July 7, 2023. Per the admission agreement, R1 was to receive a pro-rated credit for monthly care fees. LPA found that due to a clerical error, R1 was overcharged $3,400.00 in monthly care fees during R1's absence from the facility.

Although LPA determined that the overcharge did not occur due to the facility operating in bad faith, the allegation of "Staff overcharged resident for care" is valid.

Based on interviews conducted and record review, the preponderance of evidence standard has been met; therefore, the allegation was found to be SUBSTANTIATED. The facility will be cited per California Code of Regulations, Title 22, regulation 87507(f).

An exit interview was conducted, and a copy of this report was discussed and provided to Administrator Farish along with a Confidential Names List (LIC 811) and LIC9099-D.

*This is an amended version of the original report.

SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (951) 248-0350
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 18-AS-20230728094657
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: LAS VILLAS DEL NORTE
FACILITY NUMBER: 374604294
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/05/2024
Section Cited
CCR
87507(f)
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(f) The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. This requirement was not met as evidenced by:
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Licensee stated that the facility will implement a policy to ensure that the facility's new Business Office Director will receive additional training regarding the admission agreement and refund policies.
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Based on interviews and record review, the licensee did not complye with the requirement noted above by overcharging Resident 1 for care. This poses a potential health and safety risk to persons in care.
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Licensee stated that POC to be submitted to CCLD by close of business on 1/5/2024.
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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: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (951) 248-0350
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3