425800283-9-21-2023-29-AS-KBUY-CW32LG-20230926172930

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425800283
Report Date: 09/21/2023
Date Signed: 09/21/2023 04:23:43 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 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
09/01/2023 and conducted by Evaluator Brian Phillips

COMPLAINT CONTROL NUMBER: 29-AS-20230901084734

FACILITY NAME:	MOMENTUM WORK, INC. SANTA MARIA DAY PROGRAM		FACILITY NUMBER:	425800283
ADMINISTRATOR:	MARIA PRINCE		FACILITY TYPE:	775
ADDRESS:	3070 SKYWAY DR STE 104 & 105		TELEPHONE:	(805) 739-0451
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93455
CAPACITY:	105	CENSUS: 11	DATE:	09/21/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Judy Linares, Executive Director		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff mismanaged client's funds

INVESTIGATION FINDINGS:

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On 09/21/2023, Licensing Program Analyst (LPA) Brian Phillips conducted an unannounced subsequent complaint visit to the facility above to deliver final findings. LPA arrived at the facility, met with Executive Director Judy Linares, and announced the purpose of the visit.

On the allegation: Staff mismanaged client’s funds. It was alleged through an anonymous online complaint that a Staff member of the facility had purchased items through an online retailer using the company/facility credit card and then used a resident’s personal funds as reimbursement. The Reporting Party (RP) alleged that this was co-mingling of funds.

The California Code of Regulations regarding Safeguards for Cash Resources, Personal Property, and Valuables in Adult Day Programs, Title 22 (22 CCR) Division 6, Chapter 3 Section 82026(e)(1)(A),(f),(g),(h)(1)(A)(B)(C)(2), (i)(1)(2)(3) states in part...Contd. 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Brian Phillips
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

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 29-AS-20230901084734

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: MOMENTUM WORK, INC. SANTA MARIA DAY PROGRAM	FACILITY NUMBER: 425800283
	VISIT DATE: 09/21/2023

NARRATIVE

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“(e) Cash resources, personal property, and valuables of clients shall be separate and intact, and shall not be commingled with day program funds or petty cash. (1) The above requirement shall not prohibit the licensee from providing advances or loans to clients from day program funds. (A) Documentation of such transactions shall be maintained in the day program. (f) The licensee or employee of a licensee shall not make expenditures from clients' cash resources for any basic services as defined in Section 82001(b), or for any basic services identified in a contract/admission agreement between the client and the licensee. (g) The licensee shall not commingle cash resources and valuables of clients with those of another community care facility of a different license number regardless of joint ownership. (h) Each licensee shall maintain accurate records of accounts of cash resources, personal property, and valuables entrusted to his/her care, including, but not limited to the following: (1) Records of clients' cash resources maintained as a drawing account, which shall include a current ledger accounting, with columns for income, disbursements, and balance, for each client. Supporting receipts for purchases shall be filed in chronological order. (A) Receipts for cash provided to any client from his/her account(s) shall include the client's full signature or mark, or authorized representative's full signature or mark, and a statement acknowledging receipt of the amount and date received, as follows: ‘(full signature of client) accepts (dollar amount) (amount written cursive), this date (date), from (payor).’ (B) The store receipt shall constitute the receipt for purchases made for the client from his/her account. (C) The original receipt for cash resources, personal property or valuables entrusted to the licensee shall be provided to the client's authorized representative, if any, otherwise to the client. (2) Bank records for transactions of cash resources deposited in and drawn from the account specified in (i) below. (i) Immediately upon admission of a client, all his/her cash resources entrusted to the licensee and not kept in the licensed facility shall be deposited in any type of bank, savings and loan, or credit union account meeting the following requirements: (1) The account shall be maintained as a trust account separate from the personal or business accounts of the licensee. (2) The account title shall clearly note that the account contains client cash resources. (3) The licensee shall provide access to the cash resources upon demand by the client or his/her authorized representative.”

On 09/11/2023, LPA received multiple incident reports from the Licensee detailing that the Licensee discovered unaccounted for receipts/funds from four (4) residents accounts in (4) separate facilities overseen by the Licensee after the departure of an individual terminated Staff member on 04/18/2023. The Accounting Department of the Licensee audited each document and recorded the receipts to the correct ledgers to account for the funds...Contd. on 9099-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Brian Phillips
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20230901084734

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: MOMENTUM WORK, INC. SANTA MARIA DAY PROGRAM	FACILITY NUMBER: 425800283
	VISIT DATE: 09/21/2023

NARRATIVE

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On 09/11/2023, Licensee reported the suspected fiduciary abuse by the Staff member to Community Care Licensing Division (CCLD), filed a police report to Law Enforcement, and filed a report with Adult Protective Services (APS). The Licensee replaced all missing funds and subsequently put additional procedures in place to safeguard funds.

The Licensee will ensure that the procedures are being followed and funds are not distributed until ledgers are audited and receipts submitted. The Licensee has all Spend-Down monies sent to the corporate office to be logged and monitored. Regular spending plans to prevent large spend downs are also being implemented. The Licensee has separate Purchase Orders for each individual resident for online retailers/vendors, so no resident/client funds are co-mingled. There are separate bills for each individual resident/client, a check request sent by the Director for Spend-Down funds which the Accounting Office of the Licensee verifies, along with verifying receipts of the resident/client's previous balance. Receipts are submitted by each employee at each facility within 4 weeks for all resident/client purchases. Resident/Client money over the amount that is needed daily for individual Personal and Incidental (P&I) funds is kept in bank accounts for each resident/client. Staff #1 (S1) stated the Licensee now has less cash on hand in each facility, and more direct pay for each resident/client.

The Licensee oversees several residential facilities and Adult Day Program facilities. The individual Staff member accused of alleged financial impropriety/mismanagement of resident funds in the submitted incident reports, had never been involved with the finances of the facility above. The Staff member was only employed in the Residential facilities of the Licensee, not the Adult Day Program facility and had no contact with the client funds in the facility above.

According to interview, observation, and record review by the LPA; the facility complied with The California Code of Regulations (CCR) regarding Safeguards for Cash Resources, Personal Property, and Valuables in Adult Day Programs, Title 22 (22 CCR) Division 6, Chapter 3 Section 82026. The facility did not mismanage or co-mingle client funds. LPA received copies of the LIC 405 Record of Client’s/Resident’s Safeguarded Cash Resources for each client in care at the facility with cash resources. LPA additionally received Official Facility Account Withdraw forms for each client, which are created anytime a withdraw/disbursement is made. The official Account Withdraw forms include the client’s name, Date, Activity (What the funds were used for), Dollar Amount Disbursed, Amount Spent, Amount Returned, Staff Name, and Staff signature. LPA received copies of receipts for each purchase using client Safeguarded Cash Resources for the period between 08/01/2023-09/09/2023...Contd. on 9099-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Brian Phillips
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20230901084734

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: MOMENTUM WORK, INC. SANTA MARIA DAY PROGRAM	FACILITY NUMBER: 425800283
	VISIT DATE: 09/21/2023

NARRATIVE

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The facility maintains accurate records of accounts of cash resources, personal property, and entrusted valuables, including records of clients' cash resources maintained as an account, including current ledger accounting, with columns for income, disbursements, and balance, for each client. Receipts for cash provided to any client from his/her account(s) include the client's full signature or mark, or authorized representative's full signature or mark, and a statement acknowledging receipt of the amount and date received. The facility maintains store receipts that constitute the receipt for purchases made for the client from his/her account. Original receipts for cash resources, personal property or valuables entrusted to the licensee are provided to the client or the client’s authorized representative. The facility maintains bank records for transactions of cash resources deposited in and drawn from client accounts that clearly note the account contains client cash resources. The licensee provides access to the cash resources upon demand by the client or his/her authorized representative.

Title 22 (22 CCR) Division 6, Chapter 3 Section 82026 regulation states cash resources, personal property, and valuables of clients shall be separate and intact, and shall not be commingled with day program funds or petty cash. However, this requirement shall not prohibit the licensee from providing advances or loans to clients from day program funds. Documentation of such transactions shall be maintained in the day program. In this instance, the facility provided an advance/loan to a client from program funds to make an online purchase for the client. This transaction was maintained in the day program through receipts, and a ledger with columns for income, disbursements, and balance for the client. When interviewed by the LPA, both the Licensee and the client agreed that the purchase was an advance/loan for the client until the time when the client could reimburse the Licensee Day program funds.

Based on the information obtained, there was insufficient evidence to prove the allegation. Therefore, the allegation is deemed Unsubstantiated at this time.

Exit interview conducted. Copy of the report provided to the facility.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Brian Phillips
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

LIC9099 (FAS) - (06/04)

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