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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603172
Report Date: 12/08/2023
Date Signed: 12/08/2023 05:46:22 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/01/2023 and conducted by Evaluator Nune Margaryan
COMPLAINT CONTROL NUMBER: 28-AS-20231201155952
FACILITY NAME:NORWALK RETIREMENT VILLAFACILITY NUMBER:
198603172
ADMINISTRATOR:CHANEL A. SANCHEZFACILITY TYPE:
740
ADDRESS:11515 FIRESTONE BLVDTELEPHONE:
(562) 379-9200
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:80CENSUS: 68DATE:
12/08/2023
UNANNOUNCEDTIME BEGAN:
10:21 AM
MET WITH:Chanel SanchezTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Staff did not provide resident with a 60-day notice of rent increase.
Staff demanded financial information from resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced complaint investigation visit regarding the above allegations. LPA Margaryan met with Administrator Chanel Sanchez and explained the reason for the visit.

During this visit, LPA obtained a copy of the resident and staff rosters and reviewed Residents #1 (R1) to Resident #7 (R7) filles and obtained relevant documentation. LPA also interviewed Staff #1 (S1) through Staff #4 (S4) and Resident #1 (R1) through Resident #7 (R7).

Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023
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 28-AS-20231201155952
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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: NORWALK RETIREMENT VILLA
FACILITY NUMBER: 198603172
VISIT DATE: 12/08/2023
NARRATIVE
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Allegation: Staff did not provide resident with a 60-day notice of rent increase.
It was alleged that resident’s(R1) rent increased from $980 to $1300. Also Resident was advised that they owes $800.00 for back pay, and that they will be charged an additional $100/month to cover this outstanding balance.

Record review confirm that R1 was admitted to the facility on 05/11/2023. Admission agreement was signed by R1 with the Monthly rate $1344.82. For May,June and July R1 paid $920.00 for each month (copy of the invoice obtained by LPA). R1 was agreed to pay amount they own the facility. Administrator and Staff #2 stated that the facility has developed a payment plan for R1, due to the fact that R1 has an outstanding balance, and is not current on their rent. There are 2 portions of Payment plan: one was developed on 07/24/23 and the second on 09/05/23. Both were singed by R1. R1 was agreed to pay the amount of $125.00 beginning 08/03/23, and $100.00 beginning 10/03/23 and ending when the balance is paid in full. Interviewed Administrator and S2 stated that residents and their responsible parties always were made aware of the rate increase. Per record review, it was confirmed that the annual increase letter was sent out for residents indicating the increase. Interviewed R1, R2, R3, R5 and R7 stated that they notified by administrator about rate increase. Responsible parties for R4 and R6 will be notify with the 60 day notice if their rent will increase. At this time there is no rent increases for R4 and R6.

Based on information obtained, there was insufficient evidence to corroborate the allegation of facility not providing a 60 day notice of rental increase. Therefore, the allegation is unsubstantiated at this time.


NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20231201155952
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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: NORWALK RETIREMENT VILLA
FACILITY NUMBER: 198603172
VISIT DATE: 12/08/2023
NARRATIVE
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Allegation: Staff demanded financial information from resident
It was alleged that on an unknown date, R1 observed a female staff (no name)who deals with financial matters at the facility, demand the debit card PIN from a resident (no name) to get money out of the account for something the resident owed.

Interviewed administrator S2, S3, S4 denied the allegation. They stated that staff will never demand the debit card PIN from the residents. Interviewed S3 stated that sometimes residents asking for help to call to the bank to verify their account balance and S3 assisting them. In same cases S3 was provided personal information by residents. S3 stated that information provided voluntary. S2 confirmed that they had assisted residents with filling out financial forms and will assist with debit card PIN numbers if residents request assistance. All interviewed residents denied the allegation and indicated they have not heard other residents complaining about staff to demand their PIN. Interviewed R1 stated that staff not demand R1's card PIN and R1 didn't hear that staff demand PIN from other residents. Staff and resident interviews do not corroborate this allegation.

Based on information obtained, there was insufficient evidence to corroborate the allegation. Therefore, the allegation is unsubstantiated at this time.

Exit interview held and a copy of the report and appeal was provided to the Administrator.



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NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3