374604455-8-29-2023-08-AS-SJAB-CV8R7S-20230831124649

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604455
Report Date: 08/29/2023
Date Signed: 08/29/2023 10:29:30 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
08/02/2023 and conducted by Evaluator Ramon Serrano

COMPLAINT CONTROL NUMBER: 08-AS-20230802150635

FACILITY NAME:	IVY PARK AT OTAY RANCH		FACILITY NUMBER:	374604455
ADMINISTRATOR:	KAPLIOFF, ANGELA		FACILITY TYPE:	740
ADDRESS:	1290 SANTA ROSE DRIVE		TELEPHONE:	(619) 779-7400
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91913
CAPACITY:	137	CENSUS: 92	DATE:	08/29/2023
		UNANNOUNCED	TIME BEGAN:	09:47 AM
MET WITH:	Calais Anguiano		TIME COMPLETED:	10:39 AM

ALLEGATION(S):

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Staff did not provide 60-day notice prior to rent increase.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced complaint visit to deliver findings on the above allegation. LPA met with Executive Director Calais Angiano and we discussed the purpose of the visit and elements of the complaint.

Community Care Licensing (CCL) has investigated the above allegation. The investigation consisted of records review and interviews with facility staff.

It was reported to CCL that staff did not provide resident with a 60-day notice, prior to rent increase. It was alleged that Resident 1 (R1) (an LIC 811 Confidential Names List was provided to the facility representative to identify the clients) received a rent increase for the months of July and August 2023 without a 60-day prior notice. Records review revealed R1's POA signed an admission agreement on September 14, 2020. The admission agreement indicated the facility would give a 60 days' prior written notice to the resident/POA regarding any change in the monthly fees.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Ramon Serrano	TELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

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-20230802150635

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: IVY PARK AT OTAY RANCH	FACILITY NUMBER: 374604455
	VISIT DATE: 08/29/2023

NARRATIVE

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Statement from Executive Director (ED) on August 7, 2023 revealed the facility business office was in the middle of a "personnel transition." As a result some of the residents received a rent increase without a 60 day prior notice. ED further stated that they were actively working on issuing rent credits and/or charge reversals for any residents who may have received a rent increase without receiving their 60 day notice. ED stated that they have completed a reversal of the rent increase for R1 and they have also contacted residents and power of attorney's impacted so that they are aware of the credits applied and of any reversals of rent increase that were applied to their account.

Based upon the foregoing, the above listed allegation is substantiated. This finding means that the preponderance of the evidence standard has been met and the allegation is valid. Deficiency is cited in accordance with California Code of Regulations, Title 22, Division 6, Chapter 8 and is noted on the attached LIC 9099-D.

An exit interview was conducted with Calais Anguiano and a copy of this report and Licensee/Appeal Rights (LIC9058, 3/22) were provided to Calais Anguiano whose signature below confirms receipt of documents.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Ramon Serrano	TELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20230802150635

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: IVY PARK AT OTAY RANCH	FACILITY NUMBER: 374604455
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/29/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/11/2023 Section Cited CCR 1569.655(a)	1 2 3 4 5 6 7	“ … (a) If a licensee ...facility for the elderly increases the rates of fees for residents ... the licensee shall provide no less than 60 days' prior written notice to the residents or the residents' representatives …”	1 2 3 4 5 6 7	Executive Director Calais Anguiano stated that the facility has reversed or credited the residents that were charged a rent increase without a 60 day prior notice. The faciltiy will conduct a staff training regarding the admission agreement and requirements. POC due 9/11/23
	8 9 10 11 12 13 14	Based on records review and staff interview the licensee did not ensure that R1 was provided a 60-day prior notice to monthly rent increase. 1 in 4 of 92 persons in care. which posed a potential personal rights risk to persons 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: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Ramon Serrano	TELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

LIC9099 (FAS) - (06/04)

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