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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604353
Report Date: 04/02/2023
Date Signed: 06/27/2023 12:53:11 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
12/13/2022 and conducted by Evaluator Venus Mixson
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20221213145855
FACILITY NAME:MAJELLA ASSISTED LIVING, LLCFACILITY NUMBER:
374604353
ADMINISTRATOR:MORRISON, JIMFACILITY TYPE:
740
ADDRESS:2590 MAJELLA RD.TELEPHONE:
(760) 216-6344
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY:12CENSUS: 11DATE:
04/02/2023
UNANNOUNCEDTIME BEGAN:
12:38 PM
MET WITH:ADMINISTRATOR, JIM MORRISON.TIME COMPLETED:
01:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee did not issue refund to responsible party after resident passed away.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On June 27, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to deliver the findings on the listed allegation. LPA Mixson met with Administrator introduced herself and stated the purpose of the visit.

LPA Mixson toured the facility with the Administrator and made observations pertaining to the listed allegation. LPA Mixson requested pertinent documentation, the Administrator stated that he will email the LIC 500 and the clients roster by COBD on Friday 06/30/2023. There were no observable Title 22, Division 6, Regulation violations noted during the tour.

On December 13, 2022, Community Care Licensing (CCL), received information regarding the listed allegation. After LPA Mixson conducted staff and resident interviews, record reviews and observations pertaining to the alleged violation, there was not sufficient evidence to show that the above listed allegation did or did not occur. After evaluation of the evidence reviewed, there was not a preponderance of the evidence strand to determine if the listed allegation happened.

Information obtained from staff interviews demonstrated that attempts were made to contact the family and inform them of the refund process, but the calls went unanswered. Information obtained from the record reviews revealed that the refund process stated clearly in the Admissions Agreement and the Addendum to the Admission Agreement stated that the facility does not provide any refunds for payments within the current month. Assessments made by the LPA of the records review reveal that the Responsible Party signed the documentation. After additional staff and resident interviews information obtained demonstrated that the information pertaining to the facility does not provide any refunds was explained to the family during the orientation and tour of the facility. Therefore, the allegation findings and the outcome of the investigation are deemed to be UNFOUNDED.
A finding of Unfounded means that the evidence obtained did not demonstrate that the alleged violation occurred, and/or that the allegation was false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted, and a copy of this report was provided to the Administrator.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2023
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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