198202539-5-12-2022-11-AS-JHAD-CELRJY-20220520130445

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198202539
Report Date: 05/12/2022
Date Signed: 05/12/2022 11:27:31 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
04/30/2021 and conducted by Evaluator Ana Soto

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210430081729

FACILITY NAME:	EMERALD ISLE ASSISTED LIVING III		FACILITY NUMBER:	198202539
ADMINISTRATOR:	LAURA MARTZ		FACILITY TYPE:	740
ADDRESS:	27781 HAWTHORNE BLVD		TELEPHONE:	(310) 544-3308
CITY:	RANCHO PALOS VERDES	STATE: CA	ZIP CODE:	90275
CAPACITY:	6	CENSUS: 5	DATE:	05/12/2022
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Jessa Lescano, Care giver		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Facility staff increased the residents rent without proper notice

INVESTIGATION FINDINGS:

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THIS REPORT SUPERSEEDS REPORT DATED 8/31/2021 TO UPDATE THE INVESTIGATION FININGS.
On 5/12/2022, Licensing Program Analyst (LPA) Ana Soto initiated a complaint investigation to deliver the investigation findings. above. Today’s complaint investigation was conducted with Jessa Lescano, Care giver

The Investigation consisted of the following: On 4/30/2021 LPA Calderon interviewed witness (W1), reviewed admission agreement and invoices supplied. On 08/30/2021 LPA Calderon interviewed Administrator Laura Martz (S1) and requested R1 facility file.

The investigation revealed the following:
Allegation: Facility staff increased the residents rent without proper notice.
It is alleged Facility staff increased the residents rent without proper 60 days’ notice. On 04/30/2021 LPA Calderon interviewed W1 who stated that facility had increased service fees for R1 starting 1/15/2021.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

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

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20210430081729

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: EMERALD ISLE ASSISTED LIVING III	FACILITY NUMBER: 198202539
	VISIT DATE: 05/12/2022

NARRATIVE

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On 8/30/21, LPA Calderon interviewed the Administrator and she stated she provided R1 responsible party with a 60 day notice for the rent increase. The Administrator stated the rent is increased yearly due to inflation and higher operational cost. The Administrator stated R1 responsible party paid the increase rent amount without any complaint. The Administrator stated the 60 day notice was mailed to R1 responsible party. LPA Calderon review R1 60 day notice for rent increase and the notice was date 60 days prior to 1/15/21.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted, with Jessa Lescano, Care giver, and a hard copy was provided by hand for facility records.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

LIC9099 (FAS) - (06/04)

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