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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366426555
Report Date: 05/27/2021
Date Signed: 05/27/2021 06:58:35 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/25/2021 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210525134224
FACILITY NAME:APPEARANCE QUALITY HOMEFACILITY NUMBER:
366426555
ADMINISTRATOR:RILEY, RACHELFACILITY TYPE:
740
ADDRESS:10752 OAKWOOD AVE.TELEPHONE:
(760) 956-2800
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY:6CENSUS: 6DATE:
05/27/2021
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Caregiver Blanca GonzalezTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Facility is overcharging residents.
Facility is mismanaging residents' funds.
Facility is charging residents for basic services.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javina George arrived at the facility to investigate as well as to deliver findings for the allegation(s). LPA was greeted and granted entry by Caregiver Blanca Gonzalez. LPA George explained the purpose of the visit and discussed the elements of the allegations with the Administrator Rachel whom came to the facility and left 30 minutes after meeting with LPA. The investigation consisted of interviews, LPA's observations and review of pertinent documents.
Allegation # 1 Facility is overcharging residents.
LPA George reviewed bank statements that were provided by Administrator Rachel Riley. Upon review of the bank statements, the facility expenditures are commingled with personal expenses. Per the admission agreements the amounts being charged for rent range from $1800-$3500. The amount of income the individuals receive show a range of being overcharged ranging from $741.00 up to $2,441.00. The allegation of Facility is overcharging residents is SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021
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 18-AS-20210525134224
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: APPEARANCE QUALITY HOME
FACILITY NUMBER: 366426555
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/27/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/10/2021
Section Cited
CCR
80026(c)(e)
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80026 Safeguards for Cash Resources, Personal Property, and Valuables of Residents
(c) Except where provided for in approved continuing care agreements, no licensee or employee of a licensee shall:
(e) Cash resources, personal property, and valuables of clients shall be separate and intact, and shall not be commingled with facility funds or petty cash. This requirement is not met as evidenced by:
Based on observation, interview and records review the licensee is not keeping resident funds separate.

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The licensee shall submit an updated LIC401 monthly operating statement and submit proof to the department by 5pm on the due date indicated.
Type B
06/10/2021
Section Cited
CCR
80026(c)(e)
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80026 Safeguards for Cash Resources, Personal Property, and Valuables of Residents
(c) Except where provided for in approved continuing care agreements, no licensee or employee of a licensee shall:
(e) Cash resources, personal property, and valuables of clients shall be separate and intact, and shall not be commingled with facility funds or petty cash. This requirement is not met as evidenced by:
Based on observation, interview and records review the licensee is not keeping resident funds separate.
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The licensee will open a separate business account that will be utilized for operating the facility. Proof is to be submitted by 5pm on the due date indicated.
Type B
06/10/2021
Section Cited
CCR
80026(c)(e)
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80026 Safeguards for Cash Resources, Personal Property, and Valuables of Residents
(c) Except where provided for in approved continuing care agreements, no licensee or employee of a licensee shall:
(e) Cash resources, personal property, and valuables of clients shall be separate and intact, and shall not be commingled with facility funds or petty cash. This requirement is not met as evidenced by:
Based on observation, interview and records review the licensee is not keeping resident funds separate.
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The licensee will submit receipts showing the basic services such as hygiene items were purchased with the business account. Proof will be submitted to the department by 5pm on the due date indicated.
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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: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 18-AS-20210525134224
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: APPEARANCE QUALITY HOME
FACILITY NUMBER: 366426555
VISIT DATE: 05/27/2021
NARRATIVE
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Allegation # 2 Facility is mismanaging residents' funds.
LPA George reviewed bank statements that were provided by Administrator Rachel Riley. Upon review of the bank statements, the facility expenditures are commingled with personal expenses. LPA George observed multiple payments to a medical clinic, bakery, Costco gas, the cleaners and tea store to name a few. The allegation of facility is mismanaging residents' funds is SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

Allegation # 3 Facility is charging residents for basic services.
Interviews were conducted and the feedback provided was that the resident's are not receiving and money, and had not heard of the stimulus check nor made aware that they had received one. Administrator Rachel stated that stimulus checks were used to pay for the residents' needs, which includes basic service such as food, and hygiene items. LPA George did not observe any P & I funds logs, only the bank statements that were provided from the Administrator that confirmed that the funds are being commingled. The allegation of Facility is charging residents for basic services is SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

Based on observation, records review and interviews deficiencies will be cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and a copy of this report, 9099C, 9099D and appeal rights was provided to Caregiver Blanca Gonzalez.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3