421702848-12-4-2024-29-AS-KBUY-DC9NQC-20241224093939

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 421702848
Report Date: 12/04/2024
Date Signed: 12/04/2024 01:12:43 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/29/2023 and conducted by Evaluator Melisa Rankin

COMPLAINT CONTROL NUMBER: 29-AS-20231129151921

FACILITY NAME:	COVENANT LIVING AT THE SAMARKAND		FACILITY NUMBER:	421702848
ADMINISTRATOR:	DANIELLE TERVO-SHIFFMAN		FACILITY TYPE:	741
ADDRESS:	2550 TREASURE DRIVE		TELEPHONE:	(805) 687-0701
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93105
CAPACITY:	379	CENSUS:	DATE:	12/04/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Marjan Albert and Irene Carrillo		TIME COMPLETED:	01:25 PM

ALLEGATION(S):

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Staff falsified residents’ medical documentation
Staff billed residents for services not rendered

INVESTIGATION FINDINGS:

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On 12/04/24 at 9:35 am, Licensing Program Analyst (LPA) Rankin conducted a subsequent complaint visit to the facility above to issue final findings. LPA met with Administrator Marjan Albert and the Director of Rehabilitation, Irene Carrillo, and explained the purpose of the visit. Note, this facility has a Skilled Nursing Facility on grounds, all records pertaining to those residents was not reviewed due to Community Care Licensing (CCL) only regulates the Assisted Living and Independent Residential areas.

On the allegations: Staff falsified residents’ medical documentation and Staff billed residents for services not rendered:

Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Melisa Rankin	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

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 29-AS-20231129151921

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: COVENANT LIVING AT THE SAMARKAND	FACILITY NUMBER: 421702848
	VISIT DATE: 12/04/2024

NARRATIVE

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It was alleged by the reporting parties that staff are falsifying records when a resident is seen for Physical and/or Occupational Therapy and that the residents in care are being billed for those services. No additional information was provided by the reporting parties about the specific resident(s) who were claiming this allegation, or how the reporting party acquired the information. No contact information was provided, so CCL was unable to contact the reporting parties to obtain additional information about these allegations. To investigate the allegations, LPA Phillips conducted an initial tour of the facility on 12/07/2023, conducted a file review, acquired various documents including therapy chart notes for various residents, interviewed the Director of Nursing and Rehabilitation Director and conducted additional interviews with 2 residents.

On 12/04/24 LPA Rankin returned and conducted detail interviews with the Director of Rehabilitation. During the discussion the Director explained that staff have set schedules and hours they are to work for the week, that there is a percentage of that time that must be spent in direct therapy with residents. Each morning management reviews the recorded hours and activities conducted to ensure staff are completing assigned tasks, that they able to account for staff daily activities. Additionally, the charting records have a minute account for each activity or type of therapy conducted with each resident as well as detailed notes of what was done, how many repetitions, and the progress of the resident. When therapy notes were reviewed LPA observed that the start and completion dates matched on all records and that the time stamp of when the therapist electronically signed was within the same date of when the services were provided. LPA reviewed the following dates of services 12/01/23, 12/05/23, 12/06/23, and 2/19/24.

The charting system then transfers those notes, billable hours, and medical codes to the facilities system so that billing invoices can be generated. LPA noted that the minutes charted by therapists are turned into what Medicare deems a “unit” based on the medical code and the time provided for that code. At the end of the month, these records are reviewed for accuracy by the Director of Rehabilitation to ensure that what was captured by the facilities system matches the therapy recorded time/units.

Continued on 9099-C

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Melisa Rankin	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20231129151921

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: COVENANT LIVING AT THE SAMARKAND	FACILITY NUMBER: 421702848
	VISIT DATE: 12/04/2024

NARRATIVE

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During the review of these systems LPA was provided copies of invoices that are sent to Medicare, those codes, dates, and billed units were reviewed specifically for services provided to the Assisted Living residents from the therapist #1 (T1). LPA observed all records, notes, and units were consistent. A review of T1’s scheduled hours worked during the invoices reviewed were consistent with the time stamp of T1’s signature for the notes. LPA noted that T1 started with the facility early November of 2023. Director stated there was a time when T1 was spoken with, but it was due to T1 being new to the processes of the department and was stated as a one-time occurrence, but it was not in regard to any falsifying of records or billed units.

When asked how staff are managed or monitored, the Director stated the following are reviewed daily: therapist notes, hours of work, and any inconsistencies in timecards. If there is a concern a 1:1 is done with staff to council them on correcting any error.

LPA also interviewed Therapist #2 (T2), T2 also detailed their charting processes, record keeping, and how any issues are addressed. T2 stated if a concern is brought regarding another therapist, by family or residents, it is encouraged that they bring the concern to management. Both T2 and the Director stated there is often a cognitive element that can confuse services that were provided, or the amount of time spent in therapy. There is also the added note by both parties that some services are not “exercise” as a resident may typically understand, but more in assistance in daily living practices where a therapy is provided to residents in their living environment where therapists help them in daily practices that need to be reviewed or adjusted for the residents needs and safety.

LPA interviewed 2 residents, both residents were unable to describe their therapy, but did state that the facility ensure that they are provided what is needed in a safe and timely manner. Both residents expressed that they receive good care, and that staff are attentive and that should there be an issue they or their representative are able to address those needs.

Based on the investigation, there is insufficient evidence to support the claim that Staff have falsified residents’ medical documentation and that staff billed residents for services not rendered. This allegation is deemed Unsubstantiated at this time.

No deficiencies cited. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Melisa Rankin	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

LIC9099 (FAS) - (06/04)

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