425801580-5-29-2024-29-AS-KBUY-D5QVKC-20240529163008

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425801580
Report Date: 05/29/2024
Date Signed: 05/29/2024 09:24:41 AM

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
12/08/2023 and conducted by Evaluator Melisa Rankin

COMPLAINT CONTROL NUMBER: 29-AS-20231208110833

FACILITY NAME:	ABUNDANT CARE III		FACILITY NUMBER:	425801580
ADMINISTRATOR:	DANIEL BOND		FACILITY TYPE:	740
ADDRESS:	4589 AUHAY DRIVE		TELEPHONE:	(805) 845-8490
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93110
CAPACITY:	6	CENSUS: 6	DATE:	05/29/2024
		UNANNOUNCED	TIME BEGAN:	08:32 AM
MET WITH:	Timothy Pryko, Administrator		TIME COMPLETED:	09:45 AM

ALLEGATION(S):

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Staff did not issue a refund as required
Staff are charging resident for services not rendered

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rankin conducted a subsequent complaint visit to the facility above to issue final findings. LPA met with Timothy Pryko and explained the purpose of the visit.

During the investigation, LPA Kontilis conducted an initial visit on 12/12/2023 from 1:05pm to 4:00pm, toured the facility and obtained documents. LPA Rankin reviewed the documents, including R1’s admission agreement, Power of Attorney (POA) documents, invoices, emails, and copies of checks. During the investigation, it was discovered that Resident 1 (R1) had one person as Power of Attorney (POA) for healthcare decisions, a different person as POA for financial decisions, and a different person as the trustee of their estate, to manage financial decisions for their estate after R1’s death.
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: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

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 4

Control Number 29-AS-20231208110833

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: ABUNDANT CARE III	FACILITY NUMBER: 425801580
	VISIT DATE: 05/29/2024

NARRATIVE

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Trustee was interviewed, and Power of Attorney (POA) for financial was interviewed during the investigation.

On the allegation: Staff did not issue a refund as required. It was alleged that the facility did not refund the resident’s estate after the resident passed away. The facility issued a refund of $1678.73 on 12/21/22 to R1’s financial POA, as this was the person listed in R1’s admission agreement to issue a refund check to in the event of R1’s death. The financial POA never cashed the check, and the check was ultimately reissued to R1’s trustee on 8/2/2023 in the same amount.

An email dated 2/16/2023 from Administrator to trustee breaks down the refund that was issued. The administrator states there were 11 days of care provided in December 2022. Level I and Level II care prorated is $3905. R1’s personal belongings were removed on 12/14/2022. Per the admission agreement, the rate continues until all resident belongings were removed, which adds three more days and an amount of $1065. The facility charged Level III services for hospice residents at $100 per day which is noted in the admission agreement, which adds $1100. The facility also charged for one-on-one care for 7 days from 12/4/22 to 12/11/22, for 14 hours per day at a rate of $30/hour, which equaled $2940. This totals $9010.

The facility also charged $1973 for removing, disposing and the installation of new carpet and padding. Additionally, the facility charged $1438.27 for drywall patching and painting the walls. Administrator was interviewed about these additional charges. Administrator stated the charges were invoiced due to damage sustained. R1 painted their nails by themselves daily, used polish remover, and then painted a new color each day. The nail polish spilled on the carpet regularly through R1’s stay. Administrator stated they discussed with the financial POA that the carpet would need to be replaced when R1 moves out, and POA agreed to the charges. Administrator also stated R1 damaged the wall with their recliner, and dented the wall a bit when they reclined in the chair. Administrator stated they also explained the wall damage to the financial POA, and they would charge to have the drywall fixed and repainted, and POA agreed.

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: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20231208110833

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: ABUNDANT CARE III	FACILITY NUMBER: 425801580
	VISIT DATE: 05/29/2024

NARRATIVE

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Financial POA was interviewed and stated they agreed to the additional repair charges when the damage was brought to their attention. Financial POA asked the facility to send them an invoice and they paid it, because it was not normal wear and tear.

R1 paid $14,100 for December 2022. The total cost incurred for care and damages was $12,421.27. The facility issued a refund of $1678.73. Based on the information obtained, the allegation is deemed Unsubstantiated at this time.

On the allegation: Staff are charging resident for services not rendered. It was alleged that the facility increased Resident 1 (R1)’s monthly amount due to an increase in the level of care. The trustee for R1’s estate stated they were unaware of the increase. R1’s Admission Agreement was signed 3/7/2022 by R1 and their healthcare POA (authorized representative). The Admission Agreement states on pages 4 to 5 the care levels offered by the facility; Level I, Level II, and Level III. It states Level I is for more independent residents and is included in the basic services fee. Level II offers additional care such as transferring, incontinence care and/or assistance with feeding for an additional $500 per month. Level III is for residents who rely on staff for “extensive assistance” with activities of daily living. It also states hospice residents and bedridden care is considered Level III and states it will be an additional fee of $100 per day.

R1 went onto hospice on 6/21/2022. However, the facility made a billing mistake and did not charge R1 the additional $100 per day hospice/Level III care fee until 11/30/2022 per an invoice reviewed. The invoice shows back-billing for additional charges due to the resident being on hospice from June 2022 through November 2022, totaling $19,400.

Administrator stated he spoke with the healthcare POA and financial POA, and they knew R1 would be going on hospice and knew about the level of care changes and increase. Administrator stated they were fine with the extra fees based on the admission agreement that was signed. In November 2022, the licensee realized the billing error. Administrator stated they spoke to the healthcare POA about it, and they stated to go ahead and make an invoice. Administrator stated it was a clear clerical error.

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: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20231208110833

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: ABUNDANT CARE III	FACILITY NUMBER: 425801580
	VISIT DATE: 05/29/2024

NARRATIVE

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Financial POA verified there had been a billing error. They stated they signed the original admission agreement with the resident and agreed to the hospice fee of $100 per day. A letter from facility was given to LPA Rankin stating that on 06/19/2022 a letter was signed by the Financial POA confirming and approving the additional $100 per day Hospice charge. In addition when R1 went on hospice they verbally discussed the extra charges and agreed to them as well, but did not realize they were not on the invoices. POA stated when the billing error was brought to their attention, they told the facility to send an invoice and they paid it. Financial POA stated they believed the facility took good care of R1. Based on the information obtained, the allegation is deemed Unsubstantiated at this time.

Exit interview conducted, copy of report given.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Melisa Rankin	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

LIC9099 (FAS) - (06/04)

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