374604802-8-12-2024-08-AS-JLOT-D8CRPH-20240821131156

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604802
Report Date: 08/12/2024
Date Signed: 08/12/2024 03:56:43 PM

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
08/05/2024 and conducted by Evaluator Rebecca A Ruiz

COMPLAINT CONTROL NUMBER: 08-AS-20240805101045

FACILITY NAME:	SUNRISE OF OCEANSIDE		FACILITY NUMBER:	374604802
ADMINISTRATOR:	MOORE, LAUNA		FACILITY TYPE:	740
ADDRESS:	4845 MESA DR		TELEPHONE:	(408) 962-2982
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92056
CAPACITY:	136	CENSUS: 56	DATE:	08/12/2024
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Resident Care Director Anthony Bawalan		TIME COMPLETED:	03:55 PM

ALLEGATION(S):

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Licensee did not issue a refund of pre-admission fees

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint visit to open an investigation and deliver findings regarding the above mentioned allegation. LPA was greeted by, identified herself to, and explained the purpose of the visit and the basic elements of the complaint with Resident Care Director Anthony Bawalan. Executive Director Melon Rivera arrived during the visit.

During today’s visit, LPA toured the facility, observed residents in care, reviewed and obtained copies of facility records, and interviewed staff. LPA was away from the facility for approximately one hour between 12:15pm and 1:15pm.

The Department's investigation consisted of interviews with staff and outside sources, records review, and a tour of the facility. It was alleged that the Licensee did not issue a refund of pre-admission fees.

Continued on LIC9099-C page...

Substantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2024

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-20240805101045

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: SUNRISE OF OCEANSIDE	FACILITY NUMBER: 374604802
	VISIT DATE: 08/12/2024

NARRATIVE

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Interviews with staff and outside sources revealed that sometime in March 2024, Applicant 1 (A1) expressed interest in moving in to the facility and paid the facility a $2,000 pre-admission deposit to hold a spot at the facility. [Executive Director was provided with an LIC811 Confidential Names List to identify A1.] Interviews with outside sources revealed that sometime in April 2024, A1 decided not to move into the facility and requested a refund of the pre-admission deposit via telephone. Interviews with staff revealed that the pre-admission deposit is fully refundable prior to move in and individuals must request a refund in writing using a facility provided form. Interviews with staff revealed that facility staff had difficulty getting in contact with A1 to complete the paperwork, partially due to A1 living at another licensed facility. Staff stated during interviews that the facility mailed the refund paperwork to A1 on least two occasions with no response. Staff also stated that they reached out to the staff at the facility A1 was residing at and requested assistance to have A1 complete the refund paperwork with no response. Interviews with staff and outside sources revealed that sometime in May 2024, a staff member from the facility's sales department met with A1 in person to complete the refund paperwork. Review of the refund request forms for A1 revealed that the paperwork to refund for A1's pre-admission deposit was completed on 5/9/2024 and 5/22/2024. Review of an email to the facility's external billing department revealed that the facility submitted A1's refund paperwork to be processed on 6/5/2024.

Staff and outside sources confirmed during interviews that staff did not complete a formal care assessment for A1 and A1 never took possession of an apartment at the facility. Review of A1's ledger report generated on 8/12/2024 revealed that A1 has not been issued a refund for the pre-admission deposit totalling $2,000.

The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of the evidence has been met, therefore, this allegation is deemed substantiated. The following deficiency is cited per CA Code of Regulations Title 22 and noted on the attached LIC9099-D page.

An exit interview was conducted with Executive Director Melon Rivera, whose signature below confirms receipt of a copy of this report, the LIC811, and the Licensee Appeal Rights (LIC9058 3/22).

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2024

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20240805101045

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: SUNRISE OF OCEANSIDE	FACILITY NUMBER: 374604802
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/12/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/09/2024 Section Cited CCR 87507(g)(5)(E)(1)(a)	1 2 3 4 5 6 7	87507 Admission Agreements (g)(5)(E) Preadmission fees shall be refunded according to the following conditions (1) A 100 percent refund... shall be provided... if (a) the applicant decides not to enter the facility prior to the facility completing a preadmission appraisal.	1 2 3 4 5 6 7	Executive Director stated that the facility now has a Business Office Coordinator who is responsible for processing all refunds in-house. The refund for A1 is being processed and the facility will be mailing the refund via check to A1's residence via certified mail.
	8 9 10 11 12 13 14	This requirement has not been met as evidenced by: Based on interviews and records review, the licensee did not provide A1 with a refund of the $2,000 pre-admission fee. This poses a potentional personal rights risk to 56 of 56 residents in care.	8 9 10 11 12 13 14	Executive Director will provide tracking information confirming A1's refund to the Department by POC due date of 9/9/2024.
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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: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2024

LIC9099 (FAS) - (06/04)

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