425800464-10-13-2020-29-AS-KBUY-BUFQ47-20201016114951

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425800464
Report Date: 10/13/2020
Date Signed: 10/13/2020 04:46:07 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
07/22/2020 and conducted by Evaluator Lyndia Sager

COMPLAINT CONTROL NUMBER: 29-AS-20200722155200

FACILITY NAME:	VISTA DEL MONTE		FACILITY NUMBER:	425800464
ADMINISTRATOR:	DOUGLAS TUCKER		FACILITY TYPE:	741
ADDRESS:	3775 MODOC ROAD		TELEPHONE:	(805) 687-0793
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93105
CAPACITY:	266	CENSUS: 174	DATE:	10/13/2020
		UNANNOUNCED	TIME BEGAN:	04:15 PM
MET WITH:	Ali Reynoso, Director of Health Services		TIME COMPLETED:	04:28 PM

ALLEGATION(S):

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The resident and responsible party were charged for services not rendered.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Lyndia Sager conducted a subsequent complaint investigation to deliver final investigation findings telephonically due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures.

On the allegation: The resident and responsible party were charged for services not rendered. LPA Sager conducted interviews with complainant and administrator and reviewed pertinent documents.

On 05/31/20, resident #1 (R1) had a fall at the facility and was admitted to the hospital and then transferred to a Skilled Nursing Facility at R1’s family request. Administrator informed R1’s family the facility was able to care for R1 but the family preferred an outside Skilled Nursing Facility. R1’s family questioned why R1 was being charged for the time period away from the facility (05/31/20 - 07/06/20). Administrator explained to the family that the admission agreement states that the room and board rate would remain due even when a resident is not at the facility. Continued on 9099-C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Lyndia Sager	TELEPHONE: (805) 680-7683
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2020

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-20200722155200

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: VISTA DEL MONTE	FACILITY NUMBER: 425800464
	VISIT DATE: 10/13/2020

NARRATIVE

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LPA reviewed the admission agreement which states the monthly fee is due when you are absent from the facility, even if you are at a Skilled Nursing Facility.

R1 transferred from the Independent Living portion of the facility to the Summer House Memory Care portion of the facility on 01/13/20. R1’s family stated they were never informed when the contract changed for basic rate and level of care changes. LPA reviewed copies of the Care Conference and Health and Wellness Review dated 02/11/20, which stated the monthly fee for all inclusive care. These documents were signed by R1’s designated representative/family member. LPA confirmed that R1's family has been paying the new monthly fee since 01/13/20.

LPA reviewed the “Transfer Form Amendment to the Admission Agreement” and the “Appendix N Specific Services Agreement: Memory Care” forms dated 01/13/20 but not signed by resident/resident responsible party or the facility representative. Licensee will be cited for this deficiency under a future Case Management visit.

LPA reviewed the final billing for R1 dated 07/06/20 which included credits for meals during the time period R1 was away from facility (05/31/20 – 07/06/20). The billing also included credits for telephone and cable t.v. The facility waived the 60-day notice to vacate. R1’s family agreed to and paid the final billing amount.

This agency has investigated the complaint allegation regarding the resident and responsible party were charged for services not rendered. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

A telephonic exit interview was conducted and a copy of report was provided via email for signature.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Lyndia Sager	TELEPHONE: (805) 680-7683
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2020

LIC9099 (FAS) - (06/04)

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