397002740-11-5-2021-27-AS-LKIG-C8L2ZJ-20211108165026

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 397002740
Report Date: 11/05/2021
Date Signed: 11/05/2021 04:57:12 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/27/2021 and conducted by Evaluator Ashley Boothe

COMPLAINT CONTROL NUMBER: 27-AS-20210827101759

FACILITY NAME:	SUNRISE HOMES		FACILITY NUMBER:	397002740
ADMINISTRATOR:	ELIZABETH ABESA		FACILITY TYPE:	740
ADDRESS:	8100 S. BRIGHT ROAD		TELEPHONE:	(209) 234-2550
CITY:	FRENCH CAMP	STATE: CA	ZIP CODE:	95231
CAPACITY:	15	CENSUS: 10	DATE:	11/05/2021
		UNANNOUNCED	TIME BEGAN:	03:45 PM
MET WITH:	Elizabeth Abesa		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Financial Malfeasance

INVESTIGATION FINDINGS:

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On 11/5/2021 at 3:45pm Licensing Program Analyst (LPA) Ashley Boothe arrived to deliver complaint investigation findings with the following allegations: Financial Malfeasance. LPA met with Administrator and stated the purpose of the visit and was allowed entry to the facility. Today's Census 10.

During the course of the investigation the Department reviewed records, conducted interviews and on site inspection. Administrator engaged in two instances of financial malfeasance for accepting rent and personal and incidental payments knowing R1 was not in care and would not be returning. Administrator was notified by Social Security Administration that rents could not be kept after 30 days when a resident is admitted to hospital or other care. The first instance from November 2018 through April 2019 in total of $6070 for rent and personal monies. The second instance from mid March 2021 through June 2021 in total of $4725 for rent. Administrator admitted the facility could not provide the level of care needed, however did not report to R1’s payee and continued to receive funds until contacted.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Ashley Boothe	TELEPHONE: (916) 708-7751
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021

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 27-AS-20210827101759

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: SUNRISE HOMES	FACILITY NUMBER: 397002740
	VISIT DATE: 11/05/2021

NARRATIVE

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Continued from 9099.

Facility Admissions Agreement states rate shall be $1350 per month. Section 18, termination of contract, states the agreement will be terminated upon the determination of the resident’s needs and transitions into a higher level of care. Section 9, refund policy, would not apply as administrator repeatedly informed Hospital and SNF she would not be able to provide the level of care needed for R1.

Based on information obtained the aforementioned allegation is SUBSTANTIATED. A finding that the complaint is substantiated means the preponderance of evidence standard has been met, therefore the allegation is found to be substantiated.

Per California Code of Regulations (CCRs) - Title 22, Division 8, the following deficiencies are being cited on the attached 9099D during this visit. A copy of their rights (LIC9058) provided and a signature on this form acknowledges receipt of these rights. Exit interview held and a copy of report provided.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Ashley Boothe	TELEPHONE: (916) 708-7751
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20210827101759

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: SUNRISE HOMES	FACILITY NUMBER: 397002740
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/05/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied Type B 11/19/2021 Section Cited CCR 1569.58(a)(5)	1 2 3 4 5 6 7	(a) The department may deny an application for a license or may suspend or revoke a license issued under this chapter upon any of the following grounds and in the manner provided in this chapter: (5) Engaging in acts of financial malfeasance concerning the operation of a facility, including, but not limited to, improper use or embezzlement of client moneys and property or fraudulent appropriation for personal gain of facility moneys and property, or willful or negligent failure to provide services for the care of clients. This requirement is not met as evidence by:	1 2 3 4 5 6 7	The Licensee agrees to submit a written declaration to pay R1’s payee to LPA by POC due date. All payments made in total of $10795 shall be paid R1’s payee no later than 6 months from today’s date.
	8 9 10 11 12 13 14	Based on observation, interview and record review the Licensee did not comply with the section cited above in that the Administrator engaged in financial malfeasance by securing R1’s rent and personal monies while R1 was not in care which poses a potential health, safety, and personal rights risk to residents 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: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Ashley Boothe	TELEPHONE: (916) 708-7751
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021

LIC9099 (FAS) - (06/04)

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