567609954-12-8-2022-29-AS-DPEA-CN2TLN-20230113134947

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 567609954
Report Date: 12/08/2022
Date Signed: 12/08/2022 02:10:02 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, 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
12/02/2022 and conducted by Evaluator Kelly Dulek

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20221202121333

FACILITY NAME:	ARTESIAN OF OJAI, THE		FACILITY NUMBER:	567609954
ADMINISTRATOR:	MICHAEL O'NEILL		FACILITY TYPE:	740
ADDRESS:	203 E EL ROBLAR DRIVE		TELEPHONE:	(805) 798-9305
CITY:	OJAI	STATE: CA	ZIP CODE:	93023
CAPACITY:	72	CENSUS: 44	DATE:	12/08/2022
		UNANNOUNCED	TIME BEGAN:	10:54 AM
MET WITH:	Michael O'Neill		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Facility staff did not provide refund to resident's responsible person

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct an initial complaint inspection for the allegation listed above. LPA arrived at 10:54AM and met with Executive Director Michael O'Neill. Entrance interview conducted.

During today's visit, LPA interviewed Executive Director at 10:57AM, facility staff at 11:47AM, reviewed and gathered copies of pertinent documents, and conducted a tour of the facility along with Executive Director O'Neill at 01:34PM. The following was then determined:

It was alleged that the facility staff did not provide a refund to the family of Resident #1 (R1) after R1 passed away mid-September. Interview with Executive Director confirmed that as of today's date, no refund has been issued for amounts overpaid during the time R1 resided at the facility. Interview revealed that the amount of the refund owed to R1's family is being disputed, and therefore no refund has been issued to date. R1's
Report Continued on LIC 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022

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 5

Control Number 29-AS-20221202121333

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: ARTESIAN OF OJAI, THE	FACILITY NUMBER: 567609954
	VISIT DATE: 12/08/2022

NARRATIVE

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responsible party had paid via check to the facility and the facility had also received payment via check from R1's long term care insurance, thereby creating an overpayment on R1's account. R1's Admission Agreement states that "discharge/death - any refund of the monthly fee that is owed to the Resident/Representative will be returned within fifteen (15) days." As the resident passed away on 09/13/2022, and today's date is 12/08/2022, it is beyond the stated refund time frame. Therefore, based on interview and record review, the allegation that "facility staff did not provide refund to resident's responsible person" is deemed SUBSTANTIATED at this time.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 9009-D):

Exit interview conducted, todays reports and appeal rights were reviewed and emailed to the Executive Director.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 29-AS-20221202121333

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: ARTESIAN OF OJAI, THE	FACILITY NUMBER: 567609954
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/08/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/22/2022 Section Cited HSC 1569.652(c)	1 2 3 4 5 6 7	§1569.652 Termination of admission agreement upon death of resident... and refunds (c) A refund of any fees paid in advance...shall be issued...to the resident’s estate, within 15 days after the personal property is removed. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The amount the Artesian believes is owed wiill be paid to the Authorized Representative and Administrator will send proof of refund issued by POC due date. Additionally, Administrator agreed to continue to work with family's representative to reconcile the account.
	8 9 10 11 12 13 14	Based on interview and record review, the facility did not comply with the above cited section, as R1 passed away on 09/13/2022 and no refund has been issued to date, which poses a potential personal rights risk to persons 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: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 5

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
12/02/2022 and conducted by Evaluator Kelly Dulek

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20221202121333

FACILITY NAME:	ARTESIAN OF OJAI, THE		FACILITY NUMBER:	567609954
ADMINISTRATOR:	MICHAEL O'NEILL		FACILITY TYPE:	740
ADDRESS:	203 E EL ROBLAR DRIVE		TELEPHONE:	(805) 798-9305
CITY:	OJAI	STATE: CA	ZIP CODE:	93023
CAPACITY:	72	CENSUS: 44	DATE:	12/08/2022
		UNANNOUNCED	TIME BEGAN:	10:54 AM
MET WITH:	Michael O'Neill		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Facility staff did not provide itemized statements to resident's responsible person.

INVESTIGATION FINDINGS:

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13

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct an initial complaint inspection for the allegation listed above. LPA arrived at 10:54AM and met with Executive Director Michael O'Neill. Entrance interview conducted.

During today's visit, LPA interviewed Executive Director at 10:57AM, facility staff at 11:47AM, reviewed and gathered copies of pertinent documents, and conducted a tour of the facility along with Executive Director O'Neill at 01:34PM. The following was then determined:

It was alleged that the facility did not provide itemized statements to Resident #1 (R1)'s responsible party. LPA reviewed invoices from July 2021 when R1 moved into the facility until September 2022, upon R1's passing. All invoices reviewed contained itemized charges, however itemized payments are not reflected in the invoices. Each month shows a total paid, but does not include the check number or overpayment
Report Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022

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

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 29-AS-20221202121333

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: ARTESIAN OF OJAI, THE	FACILITY NUMBER: 567609954
	VISIT DATE: 12/08/2022

NARRATIVE

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amounts, in the form of a credit. Interview revealed that individual monthly invoices are reviewed on the 24th of each month for accuracy, then sent via email that same day to the resident or resident's responsible party. The system will notify the facility staff if the email does not go through, then the facility staff can review and resend as necessary. In the case of R1's invoices, LPA viewed the electronic system, which contained R1's responsible party's email for distribution. Therefore based on interview and record review, although the allegation may be valid, at this time there is insufficient evidence to support the allegation or that a violation occurred; as thus, the allegation that "facility staff did not provide itemized statements to resident's responsible person" is deemed UNSUBSTANTIATED at this time.

No citations issued in regard to this allegation. Exit interview conducted. A copy of the report was provided via email.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022

LIC9099 (FAS) - (06/04)

Page: 5 of 5