565850111-8-9-2023-29-AS-DPEA-CV5VVA-20230828164600

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850111
Report Date: 08/09/2023
Date Signed: 08/09/2023 04:58:42 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 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
07/14/2023 and conducted by Evaluator Esther Cortez

COMPLAINT CONTROL NUMBER: 29-AS-20230714150808

FACILITY NAME:	LEXINGTON ASSISTED LIVING		FACILITY NUMBER:	565850111
ADMINISTRATOR:	ERIC TERRILL		FACILITY TYPE:	740
ADDRESS:	5440 RALSTON ST		TELEPHONE:	(805) 644-6710
CITY:	VENTURA	STATE: CA	ZIP CODE:	93003
CAPACITY:	125	CENSUS: 83	DATE:	08/09/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Ashley Villareal-Family Advisor		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Facility refuses to reimburse former resident's POA

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Esther Cortez conducted a subsequent complaint visit to the facility at 08:30 a.m. to deliver the findings for the above allegation. The LPA met with Ashley Villareal, Family advisor, and the reason for the visit was explained. Wellness Director Justin Ramirez arrived shortly after.

During the initial visit on 7/20/2023, between 1:20 p.m. and 3:00 p.m., the LPA toured the physical plant with administrator Joanna, obtained pertinent documents, interviewed two (2) staff and the administrator.

Report will continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20230714150808

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: LEXINGTON ASSISTED LIVING	FACILITY NUMBER: 565850111
	VISIT DATE: 08/09/2023

NARRATIVE

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It was alleged that the facility refused to reimburse former resident’s Power of Attorney (POA). It was reported that the facility refused to return a community fee of $3500, and a holding fee of $2000 bringing the total amount of refund due to $5500 for Resident #1’s (R1) POA. Interviews confirmed that R1’s family started to move in belongings to the facility in June, however facility was notified on 06/27/2023 that R1 will no longer be moving into the facility. Information gathered reflected that a refund was initiated on 7/5/2023 through a system called Ultimus, however it is unknown why R1’s POA did not receive the refund. Staff interviews revealed that a refund for the community fee of $3500 was issued, however staff claims there was a $2,100.06 room and board fee paid by R1’s POA that was issued a prorated refund based on 30 days. Records indicated that a check for $3,599.94 was created and sent out to the address on file for R1’s POA. Furthermore, administrator Joanna stated that if the check sent out to R1’s POA was not cashed within a given amount of time, they would check in with their service center to place a stop on the check and reissue a new refund.

During todays visit, Business Manager Mayra Gutierrez stated that their system reflected the refund check sent to R1’s POA had already been cashed.

Based on the information gathered during interviews and record review, the department does not have sufficient evidence to determine that the facility refused to reimburse former resident’s POA. Therefore, the above allegation is deemed Unsubstantiated at this time.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

LIC9099 (FAS) - (06/04)

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