425850025-6-10-2024-29-AS-KBUY-D6MQJ6-20240627121214

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425850025
Report Date: 06/10/2024
Date Signed: 06/10/2024 10:54:43 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
05/20/2024 and conducted by Evaluator Melisa Rankin

COMPLAINT CONTROL NUMBER: 29-AS-20240520154222

FACILITY NAME:	SANTA MARIA TERRACE		FACILITY NUMBER:	425850025
ADMINISTRATOR:	ENRIQUEZ, SANJUANA		FACILITY TYPE:	740
ADDRESS:	1405 E MAIN ST		TELEPHONE:	(805) 925-8713
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93454
CAPACITY:	140	CENSUS: 94	DATE:	06/10/2024
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Sanjuana Enriquez, Administrator		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff did not provide proper notification of rate increase.
Facility staff did not communicate with authorized representative.

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 Sanjuana Enriquez and explained the purpose of the visit.

On the allegation: Staff did not provide proper notification of rate increases. It was alleged the facility did not notify the Family 1 (F1) for Resident 1 (R1) that there would be rate increases.

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: 06/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2024

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 3

Control Number 29-AS-20240520154222

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: SANTA MARIA TERRACE	FACILITY NUMBER: 425850025
	VISIT DATE: 06/10/2024

NARRATIVE

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Interviews conducted on 5/24/24 at 3:45 pm and 5/31/24 at 8:10 am with F1 resulted in F1 stating no notification of increases had been provided prior to the invoices being received. F1 provided invoices showing the increases effective 9/1/23 and a second increase effective 4/5/24. F1 stated they had attempted to contact the facility administration regarding the increases starting in February to May of 2024 with no response until a conversation and email were done with the Business Office Manager on 5/20/24. F1 stated this was the first time they had received this notice.

During the interview with F1 they stated in April 2024 the facility placed a “bracelet” on R1, following that F1 drove to the facility to discuss this with the administrator. Per F1, this discussion regarding the “bracelet” did occur in person. F1 did not state they addressed the increase concern with the administrator during this meeting.

On 5/28/24 at 9:45 am LPA Rankin arrived at the facility and at 10:00 am requested copies of admission agreements, fee schedules, financial invoices, and correspondence / notifications for R1. LPA reviewed invoices dated 7/1/23 to 6/1/24. LPA requested documents showing correspondence for a sampling of residents that had been notified of rate increase over the past year, as well as any of R1’s notifications. Copies of notifications were provided promptly.

The documents provided during the visit showed a letter dated 7/3/23 for R1, addressed to “(name of R1) C/O (name of F1)” showing the 60-day notification of the first-rate increase effective 9/1/23, and a document showing a 60-day notification of a second-rate increase for a “revised resident assessment” putting R1 into Level II range, this was dated 2/5/24 with the rate increase taking effect 4/5/24. The invoices provided to the LPA by both parties show the increases started per the effective date noted on the 60-day notifications. Notifications both have “First Class Mail” noted at the top of the letter. LPA provided assistance and recommended the facility send rate increase notices via certified mail, email, or somehow document notification was sent to show proof of correspondence.

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: 06/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 29-AS-20240520154222

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: SANTA MARIA TERRACE	FACILITY NUMBER: 425850025
	VISIT DATE: 06/10/2024

NARRATIVE

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In a telephone interview on 5/30/24 at 3:21 pm, Administrator stated she had seen F1 on various occasions, one of which was during a visit to discuss R1’s Wander guard bracelet. The administrator stated during that in-person discussion, at no time did F1 bring up the concern of the rate increase. Administrator stated F1 visits R1 regularly and has not tried to discuss rate increases.

Based on interviews, and documentation obtained, there is not enough evidence to prove the allegation of, “Staff did not provide proper notification of rate increase” and it is unsubstantiated at this time.

On the allegation: Facility staff did not communicate with authorized representative. LPA interviewed F1, who stated they have made attempts to contact facility administration and have not received responses. F1 does not have any documents in writing showing the attempts, and both parties have stated they had conversations in April and the rate increase concern was not brought up.

When LPA spoke with Administrator to confirm her process for responding to and communicating with family and residents, she stated she and her staff have been responding to inquiries in a timely manner. She also stated that when voicemails are left, the voicemail is sent to her email so when she isn’t in-person at the facility, she is still getting notified so she can respond promptly, the same process occurs for Amy Bowman. On 6/10/24 an advisory was given to document conversations, and/or possibly follow-up with emails with residents and/or family who are appearing to start to elevate concerns so that they can provide documentation and support that all efforts were made to respond to concerns.

Based on interviews and the information obtained, there is not enough evidence to prove the allegation of, “Facility staff did not communicate with authorized representative” and it is 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: 06/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2024

LIC9099 (FAS) - (06/04)

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