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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191600749
Report Date: 01/29/2025
Date Signed: 01/29/2025 02:58:04 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/27/2024 and conducted by Evaluator Wendy Gibbs
COMPLAINT CONTROL NUMBER: 11-AS-20241227121421
FACILITY NAME:VILLA SORRENTOFACILITY NUMBER:
191600749
ADMINISTRATOR:CARLA CHANFACILITY TYPE:
740
ADDRESS:23450 MADISONTELEPHONE:
(310) 539-6826
CITY:TORRANCESTATE: CAZIP CODE:
90505
CAPACITY:145CENSUS: 109DATE:
01/29/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Carla ChanTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility is overcharging resident for rent.
INVESTIGATION FINDINGS:
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On 01/29/2025, the department conducted an unannounced compliant visit to the facility listed above. The department met with Executive Director, Carla Chan and the purpose of today’s visit was explained.
During the initial visit on 12/31/2024 the department toured the facility, interviewed Staff S1-S3, interviewed Residents Responsible Party W1-W2, and received documents pertinent to the investigation. The following documents were received and reviewed, Staff Roster, Resident Roster, list of Assisted Living Waiver Residents, Billing Spread Sheet, Resident Admission Agreement, Resident Billing Statement, Resident Assisted Living Waiver Informing Notice, Resident Certification of Admission to Social Security Administrator, and Addendum to Resident Admission Agreement for rent increase.
During a subsequent visit on 01/16/2025 the department toured the facility, interviewed Residents R3-R6, and received additional documents. The following documents were received and reviewed, Resident Emergency Identification Form and Billing Spread Sheet.

The investigation revealed the following:
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025
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 11-AS-20241227121421
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: VILLA SORRENTO
FACILITY NUMBER: 191600749
VISIT DATE: 01/29/2025
NARRATIVE
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Allegation: facility is overcharging resident for rent.
The complaint allegation alleges that the facility is charging residents over the SSI/SSP amount.
During record review at the facility, the department received and reviewed R1’s Admission Agreement that states the basic services monthly rate is $1,398.07 and was agreed upon by the Responsible Party. According to the Non-Medical Out-Of-Home Care (NMOHC) Payment Standard for Individual-Licensed Facility the amount payable for Basic Services is $1,398.07. Additionally, in the Admission Agreement on page 10, the department reviewed the Addendum To Monthly Rate Increases, that states “on or before January 31st of each year, this facility shall prepare documents disclosing its average monthly rate increase at the average percentage of increase, for the service fee.” The addendum was signed and agreed upon by R1’s Responsible Party on 05/21/2024. The department received and reviewed the notice provided to R1’s Responsible Party regarding the rate change for 2025 to the amount of $1,420.07 for amount payable for Basic Services. Which is the current NMOHC Payment Standard for individuals in licensed facilities. The department additionally received and reviewed a copy of the Monthly Payment Log for December and January and observed residents who are part of the Assisted Living Waiver Program pay the amount payable for basic services.
During interviews with Staff S1-S3, were asked if there are any residents who are on the Assisted Living Waiver Program and use their SSI to pay the difference
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20241227121421
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: VILLA SORRENTO
FACILITY NUMBER: 191600749
VISIT DATE: 01/29/2025
NARRATIVE
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pay more than the amount payable for basic services, three (3) out of three (3) stated residents do not pay more than the amount payable for basic services which is $1,398.07. Additionally, during interviews with staff S1-S3, the department was informed the first notice they provided to Residents, or their Responsible Party had the incorrect amount listed on the notice. The amount listed was the NMOHC payment standard and not the amount payable for basic services. Staff S1-S3 stated when they realized the error they began calling residents to verbally inform them of the error and provide the correct amount. They additionally created a new notice to provide to Residents or their Responsible Party.
During interviews with Residents R3-R6, were asked if they pay over the amount payable for basic services of $1,398.07, four (4) out of four (4) stated they do not pay more than $1,398.07.
During interviews with Residents Responsible Party W1 and W2, were asked if they pay more than the amount payable for basic services of $1,398.07, two (2) out of two (2) stated they do not pay more than $1,398.07.

During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.



An exit interview was conducted with Executive Director, Carla Chan, and a copy of this report was provided.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3