567609703-7-7-2022-29-AS-DPEA-CH8SNC-20220812140118

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 567609703
Report Date: 07/07/2022
Date Signed: 07/07/2022 04:40:50 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/11/2020 and conducted by Evaluator Kasandra Lopez

COMPLAINT CONTROL NUMBER: 29-AS-20200811092803

FACILITY NAME:	REESEJOY CARE HOME		FACILITY NUMBER:	567609703
ADMINISTRATOR:	DELA VEGA RAMIREZ, ROBERTO		FACILITY TYPE:	740
ADDRESS:	1355 JUANITA AVE		TELEPHONE:	(805) 983-0631
CITY:	OXNARD	STATE: CA	ZIP CODE:	93030
CAPACITY:	6	CENSUS: 5	DATE:	07/07/2022
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Roberto Dela Vega Ramirez		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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Facility is committing insurance fraud
Responsible parties are not able to make contact with resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced subsequent complaint inspection at the facility today regarding the above allegations. The investigation for this complaint was initiated by LPA Heffernan on 08/18/2020. The LPA arrived at 11:15 AM and informed the caregiver the reason for the visit. The Administrator Roberto Dela Vega Ramirez was contacted and arrived at the facility at 11:35 AM.

During today's inspection, the LPA conducted a physical plant tour at 11:20 AM, reviewed facility records, and conducted interviews with the Administrator, Resident #2 (R2), Resident #3 (R3), Staff #1 (S1), and Staff #2 (S2) between 12:02 PM and 12:45 PM. S1, R2 and R3 worked at or have lived at the facility prior to the filing of this complaint.

The allegation of 'Responsible parties are not able to make contact with resident' alleged the reporting party was unable to get in contact with Resident #1 (R1) since 08/04/2020. The reporting party contacted the family of R1 but they would not give the reporting party any information for R1. Report continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

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-20200811092803

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: REESEJOY CARE HOME	FACILITY NUMBER: 567609703
	VISIT DATE: 07/07/2022

NARRATIVE

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Record review revealed R1 moved into the facility in September 2019 and passed away in November 2020.
Interviews with S1 and the Administrator revealed R1 had a personal cell phone that they kept with them at all times and R1 received phone calls on their personal cell phone and the facility land line. The Administrator and S1 could not recall if R1 changed their cell phone number while living at the facility. During a previous interview with the Administrator on 08/18/2020, they stated they recently changed the facility land line number when changing the service provider. Billing reflects new service began on 08/05/2020. The Administrator stated they verbally informed the family and responsible parties of residents of the new phone number. The Administrator stated R1 was on hospice at that time and hospice was also notified of the phone number change, along with R1's responsible party. The Administrator stated this was the only time they changed the facility phone number since operation began in February 2019. Interviews with residents revealed no issues or concerns with not receiving phone calls at the facility. Based on the information obtained, there is insufficient evidence to support the allegation of 'Responsible parties are not able to make contact with resident'. Therefore, the allegation is deemed unsubstantiated at this time.

The allegation of 'Facility is committing insurance fraud' alleged Resident #1 (R1) passed away and the licensee and hospice continued to collect Medicare for the deceased. The reporting party stated on 08/06/2020, law enforcement conducted a wellness check on R1 at the facility and they were able to make contact with R1. During the interview with the Administrator, they confirmed law enforcement came to the facility and conducted a wellness check for R1. Community Care Licensing (CCL) received this complaint on 08/11/2020. On 08/27/2020 and on 09/29/2020, CCL received Unusual Incident/Injury Reports (LIC 624) for R1. During both incidents, the report indicated the resident was hospitalized. Facility record review revealed hospital records for R1 for both of these incidents. On 11/11/2020, CCL received a death report for R1. Facility records reflect the mortuary picked up R1's body on 11/09/2020. Hospice records indicate R1 received hospice care from 12/13/2019 until they passed away on 11/09/2020. During the interviews with the Administrator, they denied receiving any funding from Medicare for R1 at any time. Review of the signed admission agreement indicates R1 was a private pay resident. Based on the information obtained, there is insufficient evidence to support the allegation 'Facility is committing insurance Fraud'. Therefore, the allegation is deemed unsubstantiated at this time.

Exit interview and report reviewed with the Administrator. A copy of the report and appeal rights were emailed.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

LIC9099 (FAS) - (06/04)

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