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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306003937
Report Date: 01/31/2024
Date Signed: 01/31/2024 01:18:16 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/29/2023 and conducted by Evaluator Rosie Quiroz
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230329142256
FACILITY NAME:LOS TIEMPOS SENIOR LIVINGFACILITY NUMBER:
306003937
ADMINISTRATOR:ROSA FIGUEROAFACILITY TYPE:
740
ADDRESS:17935 LOS TIEMPOS STREETTELEPHONE:
(714) 964-6310
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY:6CENSUS: 6DATE:
01/31/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Rosa Figueroa, Licensee/Administrator and Lesly Figueroa, Licensee RepresentativeTIME COMPLETED:
01:17 PM
ALLEGATION(S):
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-Facility is experiencing financial distress.
INVESTIGATION FINDINGS:
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 On today's date, in conjunction with Informal Meeting to address with the Licensee, CCLD's concerns regarding the on going non-compliance of the Licensee’s facility Los Tiempos Senior Living, LPA Quiroz, LPM Ortiz, LPM Montoya and RM Stanic discussed the allegation listed above.
During the course of the investigation, LPA Quiroz conducted facility inspection tour, documentation review but not limited to Residential Lease Agreement dated 6/18/2023, 60 day notice to vacate premises dated 5/1/2023, solvency audit report dated 10/9/2023 and interviews with interviewees consisting of staff, property landlord and other witnesses.
Regarding the allegation, "Facility is experiencing financial distress," the investigation revealed the following: The Department conducted a solvency audit dated 10/9/2023. Licensee Rosa Figueroa was requested to provide documentation and information needed for the solvency audit review. The deadline to submit the documentation was 8/23/23. Although some documentation was provided timely, the Licensee failed to submit all documentation by the deadline.
CONTINUED ON LIC 9099-C PAGE...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024
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 4
Control Number 22-AS-20230329142256
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: LOS TIEMPOS SENIOR LIVING
FACILITY NUMBER: 306003937
VISIT DATE: 01/31/2024
NARRATIVE
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The Audit report concluded the Licensee does not have an adequate financial plan required by law as evidence by audit requested utility bills for the period between December 2022 and May 2023. Some utility bills were provided and showed material amounts of past due on recurring basis. Electricity disconnection was also noted. Income statements/monthly operating statement LIC 401 was requested but was not provided. Instead, an operating statement for year 2022 was provided. However, the reported figures were not supported and are deemed unreliable.

Licensee provided loan documents reviewed concluded the Licensee has outstanding loans it remains unknown if the loans were paid on time, or if late feed were incurred as loan statements were not provided. Bank statements were requested but not provided. Monthly ending balances for statements that were available were compared with expenses for the bank records available. The ending balances/cash reserves were significantly lower than the monthly expenses. Negative balance was noted indicating insufficient cash reserves. Non sufficient funds, returned items, and overdraft fees noted in all 12 months.

Documentation reviewed and interview conducted with interviewee indicate Licensee failed to pay facility leases timely on recurring basis for the auditing period. Interview concluded the Licensee was behind on payments.

Property Landlord sent a vacate notice to the Licensee via email on 5/1/2023, but Licensee ignored it. In addition the lease expired and the landlord provided a lease renewal on 5/11/2023 but it was reported the Licensee refused to sign it and refused to move. However, this issue was resolved and has a current lease agreement.

In conclusion, based on documentation and information provided, Licensee does bnot have an adequate financial plan required by law and is not in good financial position, therefore based on the preponderance of available evidence we have substantiated the complaint allegation as valid and that a violation has occurred.

A copy of this report along with appeal rights and LIC 809-D were provided to Licensee at exit.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 22-AS-20230329142256
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: LOS TIEMPOS SENIOR LIVING
FACILITY NUMBER: 306003937
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/31/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/01/2024
Section Cited
CCR
87213
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87213-Finances: The licensee shall have a financial plan that conforms to the requirements of Section 87155...and shall submit such financial reports as may be required upon the written request...information or examination including interim financial statements. CONT
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Licensee is to prepare and submit quarterly profit and loss statement with supporting documents such as monthly utility bills, lease payments and loan agreements to department audit section. First quarterly documents are to be submitted by end of CONTINUE...
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This requirement is not met as evidenced by documentation and information provided, Licensee does not have an adequate financial plan required bt law and is not in a good financial position. This poses an immediate risk to residents in care.
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first quarter 4/30/2024. The second quarterly documents are to be submitted by 7/31/2023. The third quarterly documents are to be submitted by 10/31/2024 and the fourth quarterly documents are to be submitted by 1/31/2025.
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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.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024
LIC9099 (FAS) - (06/04)
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