306006400-8-25-2025-22-AS-APAO-DLENS4-20250911104228

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006400
Report Date: 08/25/2025
Date Signed: 08/25/2025 12:02:01 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
01/14/2025 and conducted by Evaluator Claudia Gutierrez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20250114153838

FACILITY NAME:	MG HEIGHTS I		FACILITY NUMBER:	306006400
ADMINISTRATOR:	RICO, CAROLYNE		FACILITY TYPE:	740
ADDRESS:	10612 LEXINGTON STREET		TELEPHONE:	(818) 572-3806
CITY:	STANTON	STATE: CA	ZIP CODE:	90680
CAPACITY:	5	CENSUS: 5	DATE:	08/25/2025
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Mae Barlahan		TIME COMPLETED:	12:20 PM

ALLEGATION(S):

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Staff financially abused resident

INVESTIGATION FINDINGS:

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An unannounced Complaint Investigation was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez regarding the allegation mentioned above for the purpose of delivering findings. LPA met with Administrator (AD) Carolyne Rico and explained the purpose of the inspection.

During the course of the investigation the following was revealed:

Per Admission Agreement, Resident 1 (R1) was admitted to the facility on July 17, 2024, and is self-responsible. The monthly rate for the basic services was listed as $2,400 with rent payment being due the 1st day of each month. A one-time pre-admission fee of $1,000 was assessed and was due upon admission. During their interview, R1 stated they did not know about a pre-admission fee but paid $1,000 security deposit for damages such as furniture damage. Per R1’s Physician Report dated on July 17, 2024, R1 is non-ambulatory but able to manage their own cash resources. On January 3, 2025, R1 reviewed their financial records and discovered numerous withdrawals had been made by Administrator (AD) Carolyne Rico from their checking account from July 28, 2024 to January 2, 2025, totaling $63,302. (Cont. LIC9099-C)

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2025

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 4

Control Number 22-AS-20250114153838

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: MG HEIGHTS I	FACILITY NUMBER: 306006400
	VISIT DATE: 08/25/2025

NARRATIVE

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On February 28, 2025, the Department subpoenaed Wescom Credit Union and received R1’s financial records. The bank statements were reviewed for the period from July 2024 to January 2025. The total amount of withdrawals made by AD were compared to the total amount of rent that should have been charged. A variance of $47,741 was noted. The total amount of withdrawals by AD was $63,302 and a total amount of $15,561 should been charged for rent, resulting in overcharges totaling $47,741. Each month’s withdrawals made by AD were compared to the monthly rent rate as follows:

On July 17, 2024 – R1 admitted to the facility. The prorated rent for July 2024 should have been $1,161 for 15 days and AD withdrew $2,264 from R1’s checking account via PayPal resulting in $1,103 overcharges.

In August 2024 – AD withdrew three times from R1’s checking account via PayPal totaling $3,808, resulting in $1,408 in overcharges, as rent for the month should have been $2,400.

In September 2024 - AD withdrew five times from R1’s checking account via PayPal totaling $5,687, resulting in $3,287 in overcharges, as rent for the month should have been $2,400.

In October 2024 - AD withdrew eight times from R1’s checking account via PayPal totaling $8,219 resulting in $5,819 in overcharges, as rent for the month should have been $2,400.

In November 2024 - AD withdrew eleven times from R1’s checking account via PayPal totaling $14,481, resulting in $12,081 in overcharges, as rent for the month should have been $2,400.

In December 2024 - AD withdrew twelve times from R1’s checking account via PayPal totaling $20,815, resulting in $18,415 in overcharges, as rent for the month should have been $2,400.

In January 2025 – AD withdrew three times from R1’s checking account via PayPal totaling $8,027, resulting in $5,627 in overcharges, as rent for the month should have been $2,400.

After R1 reported money shortage in their bank account, AD refunded overcharges to R1’s bank account totaling $39,940, however, remaining overcharge balance of $7,801 was not refunded to R1.

(Cont. LIC9099-C)

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2025

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20250114153838

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: MG HEIGHTS I	FACILITY NUMBER: 306006400
	VISIT DATE: 08/25/2025

NARRATIVE

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Based on the R1’s financial records, the preponderance of evidence standard has been met; therefore, the above allegation is found to be substantiated. Deficiencies are being cited per Title 22 Division 6 of the California Code of regulations (see LIC9099-D), and an Immediate $500 Civil Penalty is being assessed (see LIC421IM). Additional Civil Penalty is pending determination as per Health & Safety Code 1569.49(f).

An exit interview was conducted. A copy of this report, and appeal rights were left at the facility.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 4

Control Number 22-AS-20250114153838

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: MG HEIGHTS I	FACILITY NUMBER: 306006400
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/25/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/26/2025 Section Cited CCR 87468.2(a)(8)	1 2 3 4 5 6 7	(a)... residents in... residential care facilities... shall have all of the following personal rights: (8) To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation... This requirement is not met as evidenced by:	1 2 3 4 5 6 7	AD stated they will restore remaining overcharge balance of $7,801 to R1 and provide the proof to the LPA by POC date.
	8 9 10 11 12 13 14	Based on audit of R1’s financial records, Licensee did not comply with the section cited above as AD withdrew a total of $47,741 from July 28, 2024 to January 2, 2025 from R1’s bank account without authorization, which poses an immediate personal rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2025

LIC9099 (FAS) - (06/04)

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