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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496830723
Report Date: 11/18/2020
Date Signed: 11/18/2020 01:57:03 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/01/2020 and conducted by Evaluator David Leibert
COMPLAINT CONTROL NUMBER: 21-AS-20200901142609
FACILITY NAME:ALIANA ELDER HOMEFACILITY NUMBER:
496830723
ADMINISTRATOR:JONES, RICHARDFACILITY TYPE:
740
ADDRESS:4990 FILAMENT CIRCLETELEPHONE:
(707) 755-3602
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY:6CENSUS: DATE:
11/18/2020
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Ryanne Tapnio/CaregiverTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Facility did not issue proper refund.
INVESTIGATION FINDINGS:
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Licensing Program Analyst Leibert met with caregiver Ryanne for the purpose of delivering findings on the above captioned complaint allegation. The visit was conducted via tele - visit due to the COVID - 19 precautions. Complainant (C1) alleges that C1 paid Administrator (A1) with check in the amount of $6000.00 dated 5/14/2020. C1 paid A1 in the amount of $6000.00 with another check dated 5/27/2020 when the first check of 5/14 was returned for insufficient funds. At some point, both checks were paid by the bank which resulted in a total of $12,000.00 paid to A1. This resulted in an overpayment of $6,000.00, according to C1. Cancelled checks; text messages, and copies of letters have been submitted by C1 in support of the claim that Facility has not issued a proper refund. This Agency has attempted to make contact with A1 on numerous occasions via letters, e-mails, and phone messages left on A1's personal cell phone. To date, no response has been received. Based upon the records reviewed, statements made, and lack of response from the Administrator, the preponderance of evidence standard has been met. Therefore, the allegation is SUBSTANTIATED.The following deficiencies were observed (see LIC 9099D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: David LeibertTELEPHONE: (707) 588-5086
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2020
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 2
Control Number 21-AS-20200901142609
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: ALIANA ELDER HOME
FACILITY NUMBER: 496830723
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/18/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/02/2020
Section Cited
CCR
87405(d)(3)
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87405(d)(3)ADMINISTRATOR QUALIFICATIONS AND DUTIES.The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7)..(3) Ability to maintain or supervise the maintenance of financial and other records.***Based upon records reviewed and
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Administrator shall refund C1 for an overpayment in the amount of $6000.00 by POC date and submit proof of payment in order to clear the deficiency.
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statements made, this requirement has not been met as evidenced by: This agency has requested from the Administrator comment and documentation regarding C1's request for refund due to an overpayment and has received no response from Administrator. This poses potential risk to residents' financial security.
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Type B
12/02/2020
Section Cited
CCR
87755(c)
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87755(c) INSPECTION AUTHORITY OF LICENSING AGENCY. The licensing agency shall have the authority to inspect, audit, and copy resident or facility records upon demand during normal business hours....***Based upon records reviewed and statements made, this requirement has not been met as evidenced by:
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Administrator shall refund C1 for an overpayment in the amount of $6000.00 by POC date and submit proof of payment in order to clear the deficiency.
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This agency has requested from the Administrator comment and documentation regarding C1's request for refund due to an overpayment and has received no response from Administrator. This poses potential risk to residents' financial security.
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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: Carla MartinezTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: David LeibertTELEPHONE: (707) 588-5086
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2