425800837-7-23-2021-29-AS-KBUY-C57TTU-20210723150119

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425800837
Report Date: 07/23/2021
Date Signed: 07/23/2021 01:03:49 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
12/06/2019 and conducted by Evaluator Mark Jeffries

COMPLAINT CONTROL NUMBER: 29-AS-20191206131923

FACILITY NAME:	GARDEN COURT AT VILLA SANTA BARBARA		FACILITY NUMBER:	425800837
ADMINISTRATOR:	STEFANIA RADU		FACILITY TYPE:	740
ADDRESS:	227 E. ANAPAMU STREET		TELEPHONE:	(805) 963-4428
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93101
CAPACITY:	126	CENSUS: 58	DATE:	07/23/2021
		UNANNOUNCED	TIME BEGAN:	08:10 AM
MET WITH:	Administrator/Stefania Radu		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility failed to provide 60 day written notice prior to rate increase.

INVESTIGATION FINDINGS:

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At 11:00am on 07/23/2021, Licensing Program Analyst (LPA) Mark Jeffries arrived at the facility to deliver final findings to the complaint allegation listed above. LPA met with Administrator Stefania Radu and announced the reason for the visit. LPA Kontilis and LPA Jeffries conducted the investigation. LPAs conducted interviews with resident’s Power of Attorney on 12/09/2019 and 07/20/2021; interviewed Business Director on 12/13/2019 and 07/19/2021; and interviewed Administrator on 07/19/2021.

As to the allegation of, “Facility failed to provide 60-day written notice prior to rate increase.” During the investigation, it was determined through interviews, documentation review and financial statements, that Resident 1 (R1) had a Power of Attorney (POA) order, dated August 4, 2015 for all financial matters and the POA had been identified by the facility as the Responsible Party for R1. On April 29, 2019, the facility acquired R1’s signature for acknowledgement of a 60-day rate increase notice. However, the notification was not provided to the responsible party/POA of R1, nor did the facility attempt to provide notification to the responsible party/POA of R1. CONTINUED on LIC9099C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark Jeffries	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2021

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 5

Control Number 29-AS-20191206131923

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: GARDEN COURT AT VILLA SANTA BARBARA	FACILITY NUMBER: 425800837
	VISIT DATE: 07/23/2021

NARRATIVE

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LPA asked the Administrator for documentation of the signed rate increase for September of 2018, but the documents were not provided to the LPA. Because R1 had a POA, and the facility had knowledge that R1 had a POA/responsible party, the signature from R1 did not constitute a valid 60-day rate increase notification. As a result, the rate increase for May 2019, signed by R1 on April 29, 2019, resulted in R1’s bank account to be overcharged. Additionally, the facility did not produce a 60-day written rate increase notice for the pay increase implemented in September of 2018 and a 60-day notice was not provided to R1’s responsible party/POA. The two pay rate increases were not presented to, nor signed by R1’s POA, which resulted in overpayment for 11 consecutive months. An interview with the Business Director confirmed that the rate increase was not proper. The facility failed to provide 60-day written notice to the resident’s responsible party/POA prior to the rate increase. Therefore, the allegation of, “Facility failed to provide 60-day written notice prior to rate increase” is Substantiated at this time.

Exit interview, deficiency cited on 9099-D, report and appeal rights emailed.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark Jeffries	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 5

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
12/06/2019 and conducted by Evaluator Mark Jeffries

COMPLAINT CONTROL NUMBER: 29-AS-20191206131923

FACILITY NAME:	GARDEN COURT AT VILLA SANTA BARBARA		FACILITY NUMBER:	425800837
ADMINISTRATOR:	STEFANIA RADU		FACILITY TYPE:	740
ADDRESS:	227 E. ANAPAMU STREET		TELEPHONE:	(805) 963-4428
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93101
CAPACITY:	126	CENSUS: 58	DATE:	07/23/2021
		UNANNOUNCED	TIME BEGAN:	08:10 AM
MET WITH:	Administrator/Stefania Radu		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

1
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9

Financial abuse

INVESTIGATION FINDINGS:

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At 11:00apm on 07/23/2021, Licensing Program Analyst (LPA) Mark Jeffries arrived at the facility to deliver final findings to the complaint allegation listed above. LPA met with Administrator Stefania Radu and announced the reason for the visit. LPA Kontilis and LPA Jeffries conducted the investigation. LPAs conducted interviews with resident’s Power of Attorney on 12/09/2019 and 07/20/2021; interviewed Business Director on 12/13/2019 and 07/19/2021; and interviewed Administrator on 07/19/2021.

As to the allegation of, “Financial abuse.” During the investigation, it was determined through interviews, documentation review and financial statements, that Resident 1 (R1) had a Power of Attorney (POA) order for financial decisions, dated August 4, 2015, and the POA had been identified by the facility as the Responsible Party for R1. On April 29, 2019, the facility acquired a signature from R1 for acknowledgement of a 60-day rate increase notice, but R1’s responsible party/POA was not notified of the rate increase. Documentation for the rate increase for September of 2018 was not presented to the Licensing Program Analysts (LPA) when requested from the facility Administrator for evidence. CONTINUED on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark Jeffries	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 29-AS-20191206131923

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: GARDEN COURT AT VILLA SANTA BARBARA	FACILITY NUMBER: 425800837
	VISIT DATE: 07/23/2021

NARRATIVE

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The 60-day rate increase was not valid because R1’s responsible party/POA did not receive a copy. The facility error of the 60-day rate increase resulted in R1’s bank account being over charged for the period of September 2018 through July of 2019, resulting in a total overcharge of $2099.45, as determined by the facility. R1’s POA contacted the facility and a credit was made to R1’s account for the total amount of the 11 months being over charged of $2099.45. LPAs also discovered through interviews that lack of office staffing and interim administrator staffing during the time of February 2018 and November 2018 had contributed to the error in providing R1 notification of the 60-day rate increase instead of R1’s responsible party/POA. LPA interviewed Business Director, who acknowledged there were overcharges to the account. Business Director stated originally the resident was set up for automatic payment withdrawal. At a later date, the family decided to pay by check instead. Business Director stated the facility erroneously charged automatic withdrawals of R1’s account, even though R1’s POA had paid by check. At this time, it is determined that the lack of proper notice to R1’s POA was an error as was the erroneous automatic payment, and not intentional financial abuse. Therefore, the allegation of, Financial abuse” is unsubstantiated at this time.

Exit interview, report emailed.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark Jeffries	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2021

LIC9099 (FAS) - (06/04)

Page: 5 of 5

Control Number 29-AS-20191206131923

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: GARDEN COURT AT VILLA SANTA BARBARA	FACILITY NUMBER: 425800837
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/23/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/28/2021 Section Cited HSC 1569.655(a)	1 2 3 4 5 6 7	HSC 1569.655(a) If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 60 days' prior written notice to the residents or the residents' representatives…	1 2 3 4 5 6 7	Administrator agreed to read 1569.655 and will submit a signed statement of understanding and acknowledgement to CCL by 07/28/2021. To be submitted by email to LPA at mark.jeffries@dss.ca.gov
	8 9 10 11 12 13 14	Based on record review and interviews, the licensee did not provide R1’s responsible party with proper notice for the rate increase, which posed a potential 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: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark Jeffries	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 5