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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609345
Report Date: 04/21/2021
Date Signed: 04/21/2021 02:18:14 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., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/18/2020 and conducted by Evaluator Naira Margaryan
COMPLAINT CONTROL NUMBER: 31-AS-20200918111501
FACILITY NAME:CASA AMOREFACILITY NUMBER:
197609345
ADMINISTRATOR:MORALES, RITAFACILITY TYPE:
740
ADDRESS:44124 WESTRIDGE DRIVETELEPHONE:
(661) 289-0288
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:6CENSUS: 6DATE:
04/21/2021
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Rita MoralesTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Facility failed to issue proper refund after resident's death.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Naira Margaryan conducted unannounced subsequent complaint visit to the facility.
Due to the situation surrounding the Corona virus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically. The purpose of this visit was discussed with the Administrator at
It was reported that the Licensee did not refund the complete amount of unused portion of the rent after the resident #1 (R1) passed away.
During this investigation on 09/22/2020 at 10:20am and at 4:30pm, LPA Margaryan spoke with the Licensee and she stated following; R1 expired on 09/06/2020 at which time the licensee was already received the full rent for September 2021 and additional fee for an optional services. R1’s belongings were removed from the facility on 09/08/2020. Licensee and R1’s representative agreed that the total rent will be prorated and the unused portion of the rent will be refunded with partial payments. The first portion of the payment was sent on 09/09/2020 and the second portion of the unpaid rent was going to be paid by the fifteenth (15th) days after R1's belongings were removed from the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Naira Margaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2021
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 2
Control Number 31-AS-20200918111501
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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: CASA AMORE
FACILITY NUMBER: 197609345
VISIT DATE: 04/21/2021
NARRATIVE
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On 09/25/2020 at 10:30am, LPA Margaryan reviewed the records previously received from the facility. The records indicate that the15 days for applicable refund was ending on 09/23/2020 and the Licensee paid the second portion of the refund on 09/22/2020.
Based on the interviews and record review, it was concluded that although there was a delay refunding the second portion of prorated amount, the final payment was completed within 15 days after R1 belonging were removed from the facility. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Exit interview was conducted.
A copy of report was e-mailed to the Administrator for review and manual signature.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Naira Margaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2