374604388-12-15-2023-08-AS-SJAB-CYWVDU-20231227152119

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604388
Report Date: 12/15/2023
Date Signed: 12/15/2023 11:38:46 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
11/17/2023 and conducted by Evaluator Daniel Pena

COMPLAINT CONTROL NUMBER: 08-AS-20231117104603

FACILITY NAME:	SUNSET CLIFFS ELDER CARE		FACILITY NUMBER:	374604388
ADMINISTRATOR:	TRAVONNA WASHINGTON		FACILITY TYPE:	740
ADDRESS:	1039 SANTA BARBARA STREET		TELEPHONE:	(619) 791-5495
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92107
CAPACITY:	6	CENSUS: 6	DATE:	12/15/2023
		UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Gaurav Rathi, Licensee		TIME COMPLETED:	10:20 AM

ALLEGATION(S):

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Licensee did not issue resident's authorized representative a refund

INVESTIGATION FINDINGS:

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On 12/15/2023, at about 8:20 AM, Licensing Program Analyst (LPA) Daniel Pena, conducted an unannounced visit to the facility to conclude a complaint investigation. LPA Pena was greeted at the entrance by Caregiver, Hugo Duran, and after identifying himself and explaining the purpose of the visit, was allowed inside the facility. Licensee, Gaurav Rathi, later arrived and LPA discussed with him the findings of the investigation.

On 11/17/2023, the Department received this complaint which alleged the licensee did not issue Resident 1’s (R1) authorized representative a refund. The Department’s investigation consisted of review of facility, resident and outside source records, physical plant inspection, and interviews with facility staff and outside sources.

Investigation revealed that R1 was admitted to the facility on June 29, 2023, and moved out on July 5, 2023. Interviews indicated that prior to their move in; R1 underwent a surgery. Subsequent to R1’s move

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel Pena	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2023

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-20231117104603

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SUNSET CLIFFS ELDER CARE	FACILITY NUMBER: 374604388
	VISIT DATE: 12/15/2023

NARRATIVE

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in; complications with the surgery site occurred and required R1 to be transported to the hospital. Facility staff arranged for R1 to be transported to the hospital. At the hospital, R1 was diagnosed with infection to the surgery site.

Interviews indicated that R1 required antibiotic administration and closer monitoring of the wound. Interviews revealed that R1 did not return to the facility. Records show that on July 10, 2023, R1’s authorized representative submitted to the licensee a 30-day notice informing them that R1 was discharging from the facility. Records showed that on July 12, 2023, R1’s personal items were removed from the facility.

Admittedly, when interviewed, the licensee stated that they did not initially refund R1’s paid rent.
A review of R1's admission agreement was conducted. The agreement was signed by facility staff and an authorized representative for R1 on June 29, 2023. According to the Conditions for Preadmission Fee Refund (2)(b) section of the admission agreement, “If the resident leaves the facility for any reason during the first month of residency, the resident shall be entitled to a refund of at least 80 percent of the preadmission fee amount in excess of five hundred dollars ($800).”

Interviews and records confirmed that the licensee applied a credit for the preadmission fees towards remaining rent and transportation costs. The refund for preadmission fees was stipulated and clearly documented in the admission agreement.

It should be noted that specific language was not present in the admission agreement, outlining the conditions for refund of pre-paid rent upon relocation of a resident. However, it should also be noted that the facility refunded a portion of R1’s monthly rental fees on 12/15/2023.

Based on interviews and review of documentation, insufficient evidence was obtained to prove the licensee violated Title 22 Regulations related to the refund of preadmission appraisal fees. The preponderance of evidence standard was not met. Therefore, this allegation is Unsubstantiated which means there is not enough evidence to prove or disprove the allegation occurred as reported.

An exit interview was held, and a copy of this report was discussed with Licensee, Rathi. A copy of the report along with appeal rights (01/2016) were provided to Mr. Rathi at the conclusion of the visit. Mr. Rathi’s signature on this form acknowledges receipt of these rights.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel Pena	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2023

LIC9099 (FAS) - (06/04)

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