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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850072
Report Date: 12/19/2023
Date Signed: 12/19/2023 03:49:52 PM

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
12/13/2023 and conducted by Evaluator Elsie Campos
COMPLAINT CONTROL NUMBER: 29-AS-20231213094351
FACILITY NAME:SILVERADO THOUSAND OAKS, LLCFACILITY NUMBER:
565850072
ADMINISTRATOR:SABRINA PEGROSSFACILITY TYPE:
740
ADDRESS:980 WARWICK AVETELEPHONE:
(805) 307-7300
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY:82CENSUS: 46DATE:
12/19/2023
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Sabrina PegrossTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff did not refund fees according to the resident's admission agreement
Staff are billing resident for services not provided
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elsie Campos arrived unannounced to conduct an initial complaint visit for the above allegations. Upon arrival, the LPA met with Executive Director (ED) Sabrina Pegross and explained the reason for the visit.

During today's visit, the LPA along with the ED conducted a tour of the facility to ensure there are no health and safety concerns, conducted an interview with the ED at 11:00 a.m., conducted a file review at 11:20 a.m., and obtained copies of the census, staff schedule, and other pertinent documents relevant to the investigation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie CamposTELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023
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-20231213094351
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: SILVERADO THOUSAND OAKS, LLC
FACILITY NUMBER: 565850072
VISIT DATE: 12/19/2023
NARRATIVE
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Regarding the allegation, it was alleged that staff did not refund fees according to the resident's admission agreement. Resident moved into the facility on 8/30/2023. Interviews revealed that the resident and their responsible party (RP) informed staff and moved out of the facility on 10/31/2023 without a written 30 day notice, 63 days after move in. It was confirmed that on 9/20/2023, the RP was provided a credit as a courtesy, in the amount of $6,616.77 to help the resident avoid paying rent at two different facilities during the moving transition from the resident’s previous facility to Silverado Thousand Oaks. Approximately 63 days later, the RP made the decision to move out; as such, per the admission agreement ‘Termination by Resident’ it indicates “you may terminate this Agreement at any time, with or without cause, by giving the Administrator of the Community or his/her designee thirty (30) days prior written notice of termination. You need not to cite a specific reason for termination". A written notice was not received, and the RP moved forward with moving the resident out of the facility on the same day a verbal notification was given by the RP to the facility of the resident’s plan to move out, 10/31/2023.

A review of the admission agreement revealed a statement, stating that parties understand that ‘the Administrative Fee of $10,000 is partially refundable based on the time of discharge from the community, in this case the resident moved out after the 60th day of residing at the facility as they moved in on 8/30/2023 and moved out on 10/31/2023 which puts the resident in the refund window of 61-90 days following move-in: allowing a 40% refund of the Administrative Fee after a $500 fee is deducted based on the agreed terms in the admission agreement. The refund for the Administrative Fee is to be issued within thirty days (30) of submitting written notification to move-out. However, a 30 day written notice was not received by the facility and instead a verbal notice was accepted on 10/31/2023 therefore making the end of the 30 days effective December 1st, 2023.

Based on the evidence received, there is insufficient evidence to support the allegation. The above allegation is Unsubstantiated at this time.

Continued on LIC 9099-C
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie CamposTELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20231213094351
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: SILVERADO THOUSAND OAKS, LLC
FACILITY NUMBER: 565850072
VISIT DATE: 12/19/2023
NARRATIVE
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Regarding the allegation, it was alleged that staff are billing resident for services not provided. Documentation revealed that resident moved into the facility on 8/30/2023. Interviews revealed that the resident and their responsible party (RP) informed staff and moved out of the facility on 10/31/2023 without a written 30 day notice, 63 days after move in. It was confirmed that on 9/20/2023, the RP was provided a credit as a courtesy, in the amount of $6,616.77 to help the resident avoid paying rent at two different facilities during the moving transition from the resident’s previous facility to Silverado Thousand Oaks.

Approximately 63 days later, the RP made the decision to move out; as such, per the admission agreement ‘Termination by Resident’ it indicates “you may terminate this Agreement at any time, with or without cause, by giving the Administrator of the Community or his/her designee thirty (30) days prior written notice of termination. You need not to cite a specific reason for termination”. A written notice was not received by the facility from the RP, and the RP moved forward with moving the resident out of the facility on the same day a verbal notification was given by the RP to the facility of the resident’s plan to move out, 10/31/2023.

A review of the Admission Agreement revealed that the RP signed the admission agreement on 8/30/2023 and the resident moved in on the same day, acknowledging that “[they] parties have read and understood the Agreement, including its exhibits and attachments, and agreed to abide by the terms”. In this case the resident moved in on 8/30/2023 and moved out on 10/31/2023 without providing a written 30 day notice and instead a verbal notice was accepted by the facility on 10/31/2023 therefore making the end of the 30 days effective December 1st, 2023. which makes the RP responsible for the proceeding 30 days of fees generated for room and care, up until December 1st, 2023.

Based on the evidence received, there is insufficient evidence to support the allegation. The above allegation is Unsubstantiated at this time.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was provided.
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie CamposTELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3