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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 567609954
Report Date: 10/01/2024
Date Signed: 10/01/2024 03:28:11 PM

Substantiated


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
03/25/2024 and conducted by Evaluator Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20240325114827
FACILITY NAME:ARTESIAN OF OJAI, THEFACILITY NUMBER:
567609954
ADMINISTRATOR:AMBER L WINTERSTEINFACILITY TYPE:
740
ADDRESS:203 E EL ROBLAR DRIVETELEPHONE:
(805) 798-9305
CITY:OJAISTATE: CAZIP CODE:
93023
CAPACITY:72CENSUS: 36DATE:
10/01/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Michael Weyric-Ownership Representative TIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Facility overcharged resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Esther Cortez conducted an unannounced subsequent complaint visit for the above allegations. Upon arrival, LPA met with facility staff who informed the LPA that Executive Director Amber Winterstein is no longer with the Artesian of Ojai. The LPA met with facility representative Michael Weyrick and was explained the reason for the visit.

On 04/02/2024,between 12:30 p.m. and 4:30 p.m., the LPA interviewed the Care director, conducted a file review, and obtained copies of resident records and other pertinent documents relevant to the investigation.
On 08/26/2024, the LPA conducted a file review, and interviewed the Executive Director. On 10/01/2024 at 10:13 a.m. LPA conducted a phone interview with one (1) staff. During today's visit the LPA conducted two (2) staff interviews, interview with R1's authorized person and obtained pertinent documents revelant to the investigation.

Report will continue on LIC9099-C-2nd page.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
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 4
Control Number 29-AS-20240325114827
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: ARTESIAN OF OJAI, THE
FACILITY NUMBER: 567609954
VISIT DATE: 10/01/2024
NARRATIVE
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On the allegation "Facility overcharged resident "; it is the concern of the reporting party that the Artesian of Ojai has applied invalid charges and unexplained charges without the required written notice to Resident #1 (R1) and/or their authorized person (AP) and did not respond to written requests for clarification or adjustments. It was further reported that the community retro billed and charged R1 for additional services including services not provided while R1 was hospitalized from 02/04 to 02/22, 2023 and were not following their contract. To investigate the allegation the LPA conducted a file review and interviews. Information obtained and File review revealed that on 03/01/2023, R1 and/or AP received the following new charges on their invoice: $1500 for medication administration for period 01/01/2023 to 03/31/2023, $1500 for incontinence package for period 01/01/2023 to 03/31/2023, and $995 for specialized care package for period 03/01/2023 to 03/31/2023. It was reported that R1 and AP were not given notice to these new charges, and no explanation was given as to what the specialized care package fee was for.

Information obtained and file review revealed that R1’s authorized person had delivered a letter to previous Executive Director (ED), Mike O’Neil on 04/11/2023 requesting information as to what the specialized care package fee was for, and the letter was signed by the ED to acknowledging receipt of the letter. The letter also revealed that R1’s authorized person informed the ED that they had not received any notice that additional services were being provided or that a charge would be added regarding the additional charges first billed on the March invoice for incontinence care and medication administration for January 2023 and February 2023 and requested an adjustment to the invoices. In addition, the letter revealed that R1 had been in the hospital in February of 2023 and was not receiving services at the facility during that time. Furthermore, R1 was invoiced for Specialized Care Package for March, April, May, and June of 2023.

Reviewed admission agreement revealed that if a change in service level is required, written notice will be provided within two business days if the change involves a rate increase under the Notice of Rate Change section. Interview with R1’s AP revealed that they did not receive a written notice regarding any rate changes when they met with the HSD in late February of 2023 to go over R1’s service plan. Furthermore, they stated that they discussed new hospice services that were going to initiate, however a specialized care package fee for a new level of service was not discussed.

Report will continue on LIC9099-C-3rd page.

SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20240325114827
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: ARTESIAN OF OJAI, THE
FACILITY NUMBER: 567609954
VISIT DATE: 10/01/2024
NARRATIVE
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Interview with the previous Executive Director, Amber Winterstein, revealed that a resident’s rate can increase if their level of care changes, when it does the health service director will notify the resident and or their authorized person and will go over the new service care plan with them and rate increases, and have them sign to acknowledge they have reviewed. They further stated that R1’s authorized person was informed by the previous Health Service Director (HSD) that R1’s level of care had increased and there had been an increase in rate and R1’s authorized person signed the change in condition documents. However, file review revealed that the community did not have any change in condition documents signed by R1 or their authorized person acknowledging the new fees. Furthermore, the community was not able to provide a written notice of the rate increase that should have been provided to R1 and AP. The notice shall include a detailed explanation of the additional services to be provided at the new level of care and an accompanying itemization of the charges. File review also revealed that multiple email exchanges had taken place with AP and staff at the community regarding the charges, however all email exchanges reviewed were after April 2023 (charges had already been applied), and none of the emails had an explanation of the additional services provided at the new level of care. Based on the information gathered during the course of this investigation the allegation is deemed Substantiated at this time.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D).Exit interview conducted. Today's reports and appeal rights were reviewed and issued.

SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 29-AS-20240325114827
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: ARTESIAN OF OJAI, THE
FACILITY NUMBER: 567609954
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/04/2024
Section Cited
HSC
1560.657(a)
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§1569.657 Rate increase due to change in level of resident care; (a) For any rate increase due to a change in the level of care of the resident...written notice of the rate increase within two business days... itemization of the charges.
This requirement is not met as evidenced by:
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Ownership representative agrees to submit a letter of understanding of regulation 1560.657 (a) and to conduct staff training with staff that is responsible to provide written notices and submit to LPA by 10/04/2024.
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Based on interview and record review, the licensee did not comply with the section cited above as their is no proof R1 or the responsible party received written notice of the rate increase which is a potential personal rights risk to residents in care.
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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: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4