455001891-7-29-2022-25-AS-LMUZ-CGZR53-20220805124226

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 455001891
Report Date: 07/29/2022
Date Signed: 07/29/2022 03:18:59 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/15/2021 and conducted by Evaluator Misty Valencia

COMPLAINT CONTROL NUMBER: 25-AS-20211115125538

FACILITY NAME:	LIFE PASTICHE		FACILITY NUMBER:	455001891
ADMINISTRATOR:	JOHNSON, RHONDA		FACILITY TYPE:	740
ADDRESS:	19323 HOLLOW LANE		TELEPHONE:	(530) 215-1685
CITY:	REDDING	STATE: CA	ZIP CODE:	96003
CAPACITY:	6	CENSUS: 5	DATE:	07/29/2022
		UNANNOUNCED	TIME BEGAN:	09:13 AM
MET WITH:	Rhonada Johnson, Administrator		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Financial Abuse

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 07/29/2022 Licensing Program Analyst (LPA) Misty Valencia arrive for a visit to deliver findings regarding Financial Abuse as directed by the Department. LPA met with Rhonada Johnson, Administrator and explained the reason for the visit is to deliver complaint findings. Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted Administrator and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical masks. Additionally, LPA was screened by staff at the front door.

Financial Abuse

continued on 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022

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 6

Control Number 25-AS-20211115125538

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: LIFE PASTICHE	FACILITY NUMBER: 455001891
	VISIT DATE: 07/29/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Throughout the course of the investigation the department conducted interviews, reviewed documentation, and observed residents in care. Licensing Program Analyst (LPA) Misty Valencia’s review of the Trust Audit Report that was conducted by the Department’s Audits Section, revealed the department was able to substantiate Financial Abuse allegation.

On 11/15/2021 the Chico office received a complaint regarding financial abuse of a caregiver, reporting that $8,000 was given to the caregiver, (S1). On 12/28/2021 LPA received a phone call from S1, perpetrator of financial abuse asking LPA if she could go back to work at the facility. LPA interviewed S1 and S1 reported that she has received about seven (7) checks from resident totaling around $2,000.

Audit section received a trust audit request from Sacramento North Adult and Senior Care Regional Office. The licensee is Rhonda Johnson. LPA, Dawn Keane received the SOC 341 via email. Report states that S1 is a caregiver in the facility where resident, (R1) lives. Over a period of two years, S1 has accepted money from R1. The situation was without R1’s daughter’s knowledge and when R1’s daughter asked S1 about it, S1 said she has turned down money on multiple occasions, but upon R1’s insistence S1 accepted R1’s money multiple times over the years. R1 has lived at Life Pastiche since 2017, and for the last three years S1 has been one of his caregivers.

On 12/28/2021, S1 called LPA and asked if she could go back to work at the facility. LPA asked S1 to explain the situation. S1 stated that R1 has offered her money for her bills for several years. S1 reported that about a year ago she started accepting money from R1 in the form of checks. S1 stated that she received approximately seven (7) checks totaling around $2,000. S1 also reported that she tried to pay the money back to R1, but R1 refused, and R1 didn’t want to press charges.

R1, 88 years old, was admitted to Life Pastiche on 6/22/2017. The monthly private pay rate for basic service is $4,000 and an additional service charge $75 for transport to the appointments. R1 does not have a diagnosis of mild cognitive impairment or dementia, but has motor impairment and used a walker. R1 is responsible for himself, handles his own financial affairs and pays his rent every month with a check. When admitted R1 was able to manage his own cash resources but by 4/13/2018 his daughter became the Power of Attorney (POA). R1’s wife, was admitted to Life Pastiche at the same time and passed away on 4/3/2018 at the facility. The cause of death was kidney failure.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 6

Control Number 25-AS-20211115125538

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: LIFE PASTICHE	FACILITY NUMBER: 455001891
	VISIT DATE: 07/29/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

R1’s POA, described in an email dated 2/9/22 that R1 has a checking account. The account is a joint account with R1’s POA’s name on it. On 11/5/2021, R1’s POA and R1 went to the bank and saw a lot of Door Dash Charges, ATM withdrawals, checks and unusual charges on R1’s checking account printout for the months of September & October/2021. R1 did not know anything about these charges. R1’s POA questioned the care worker if R1 received door dash food. They said no. There were multiple checks made out to S1. R1’s POA didn’t think that R1 should be giving S1 checks and immediately requested the bank cancel R1’s debit card.

The Department obtained copies of R1’s monthly bank statements, cancelled checks and video surveillance for ATM cash withdraws for the period from January 2019 up to current. Based on bank records reviewed, the following information was obtained:

Bank Statements
The bank statements showed there were multiple check transactions, ATM withdrawals and numerous food delivery charges for different restaurants. The cancelled checks were reviewed and showed that there were seventeen (17) checks made out to S1, totaling $10,100 for the period from March 2020 to October 2021. The memo line noted the payments were for loan, X-Mas or help.

ATM Cash Withdraw
Bank video surveillance captured three (3) images for ATM cash
withdraws.
-On 9/28/2021 at 8:24 p.m. a woman and a man used R1’s debit card to pull out cash for $400 via ATM machine located in Redding, CA. The Licensee was able to identify the individuals using the ATM machine, as shown in the video surveillance, as S1’s daughter and her boyfriend.
-On 9/30/2021 at 7:26 p.m. a woman used R1’s debit card to pull out cash for $500 via ATM machine located in Redding CA. The Licensee was able to identify the individual using the ATM machine, as shown in the video surveillance, as S1’s daughter
-On 10/28/2021 at 6:38 p.m. a woman drove-up to an ATM located in Redding, CA and pulled out $500. S1 not only obtained and used R1’s debit card to pull out cash for herself but also let her daughter, use R1’s debit card to pull out cash as well.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 6

Control Number 25-AS-20211115125538

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: LIFE PASTICHE	FACILITY NUMBER: 455001891
	VISIT DATE: 07/29/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Food Delivery Charges
There were numerous food delivery charges from an outside food delivery company totaling $3,512.81 as shown on the R1’s bank statement, with multiple food order charges on the same day. The Department obtained records identifying customer information, including the name of the person who ordered the food and the address where the food was delivered. These records confirmed that S1’s daughter had ordered food deliveries to her home address in Redding, CA 96002 and that S1 gave her daughter R1’s debit card and allowed her to use it make various online food purchases.

The Department reviewed R1’s bank statements, cancelled checks, bank video surveillance and food delivery charges information. There were multiple checks made out to S1 totaling $10,100. Both S1 and S1’s daughter used R1’s debit card to withdraw cash via ATM for their personal financial gain.

The Department reviewed R1’s admission agreement, physician’s report, cancelled checks, bank statements, bank surveillance, and an outside food delivery service account information, which confirmed S1 received $10,100 from R1 by checks for the period from March 2020 to October 2021. S1 and S1’s daughter not only obtained R1’s debit card, but also used R1’s debit card to pull out cash via ATM for their personal financial gain. S1’s daughter linked R1’s debit card to her personal outside food delivery service account making numerous online food purchases, totaling $3,512.81 for the period from December 2020 to November 2021, and food was delivered to S1’s daughter’s home address. Due to the Licensee’s failure to exercise administrator’s duty and lack of internal supervision resulting in R1’s financial loss, the allegation that “Staff (S1) financially abused resident (R1)” is substantiated.

Based on the evidence obtained, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, (Title 22), is being cited on the attached LIC 9099D.

Plan of correction (POC) were discussed. Appeal rights were provided and exit interview conducted

Exit interview conducted, report and appeal rights emailed to Administrator.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 6

Control Number 25-AS-20211115125538

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: LIFE PASTICHE	FACILITY NUMBER: 455001891
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/29/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied: Appeal Not Submitted Timely Type A 08/01/2022 Section Cited CCR 87205(a)	1 2 3 4 5 6 7	Accountability of Licensee Governing Body (a)The licensee, whether an individual or other entity, shall exercise general supervision over the affairs of the licensed facility and establish policies concerning its operation in conformance with these regulations...	1 2 3 4 5 6 7	Licensee agree to reimburse R1, for $13,612.81 ($10,100 + $3,512.81) Licensee is to provide the Regional Office proof of payment made to R1’s or a payment plan by 08/01/2022.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: based on The licensee did not exercise internal supervision over the affairs of the facility which lead to staff financially abusing a resident for a year and a half. This poses an immediate Health, Safety and Personal Rights risk to clients in care	8 9 10 11 12 13 14
Request Denied: Appeal Not Submitted Timely Type A 08/02/2022 Section Cited CCR 87468.2(a)(8)	1 2 3 4 5 6 7	Additional Personal Rights of Residents in Privately Operated Facilities (a)(8) To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse.	1 2 3 4 5 6 7	POC already completed. licensee has new hires sign a policy regarding taking gifts from residents in care.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: based on The licensee did not protect R1 from S1's financial abuse for over a year. This poses an immediate Health, Safety and Personal Rights risk to clients in care.	8 9 10 11 12 13 14

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: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 25-AS-20211115125538

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: LIFE PASTICHE	FACILITY NUMBER: 455001891
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/29/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied: Appeal Not Submitted Timely Type A 08/01/2022 Section Cited CCR 87405(h)(5)	1 2 3 4 5 6 7	Administrator - Qualifications and Duties (h)(5) Provide or ensure the provision of services to the residents with appropriate regard for the residents' physical and mental well-being and needs	1 2 3 4 5 6 7	Licensee agrees to read Regulation 87405(h)(5) and sign a statement that it is understood and provide that statement to the department by 08/01/2022.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: based on Adminitrator did not provide supervision and security regarding one of one (1 of 1) residents financial property. This poses an immediate Health, Safety and Personal Rights risk to clients 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: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022

LIC9099 (FAS) - (06/04)

Page: 6 of 6