336406385-4-19-2026-18-AS-RORN-DTLKX5-20260429081658

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336406385
Report Date: 04/19/2026
Date Signed: 04/19/2026 03:34:42 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/12/2024 and conducted by Evaluator Christian Gutierrez

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20240112143536

FACILITY NAME:	VANDELON HOME CARE		FACILITY NUMBER:	336406385
ADMINISTRATOR:	MARK UY		FACILITY TYPE:	740
ADDRESS:	1024 HALSTEAD WAY		TELEPHONE:	(951) 765-6356
CITY:	HEMET	STATE: CA	ZIP CODE:	92545
CAPACITY:	6	CENSUS: 3	DATE:	04/19/2026
		UNANNOUNCED	TIME BEGAN:	09:28 AM
MET WITH:	Mark Uy		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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Staff did not give resident sufficient notice of rate increase
Staff are billing resident for services not rendered

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christian Gutierrez conducted a subsequent complain visit in regard to the allegations listed above. LPA met with Administrator Mark Uy, Assistant Administrator Marlon Uy, and Licensee Haide Uy explained reason for visit.

The investigation consisted of the following: During the initial visit conducted on 01/19/2024, LPA Chinwe Nwogene conducted an unannounced visit for the purpose of investigating the above allegation. LPA toured the facility, interviewed staff and reviewed resident file During today’s visit LPA Gutierrez obtained copies of the following documents: R1’s physician report, healthcare notes from 2017, appraisal needs and service plan for 2022,2024, and 2025, rate plan for 2023, Identification and emergency information, two admission agreements, shift notes from staff, APS documents, and three years of rent checks for R1. LPA interviewed Administrator, Assistant Administrator, Licensee and delivered findings.

See LIC 9099C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2026

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 5

Control Number 18-AS-20240112143536

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: VANDELON HOME CARE	FACILITY NUMBER: 336406385
	VISIT DATE: 04/19/2026

NARRATIVE

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In regard to the allegation” Staff did not give resident sufficient notice of rate increase.”, It is alleged that during R1’s stay at facility every year the rate would increase without written notification. During interview with Administrator, Assistant Administrator and Licensee all three (3) staff stated that whenever there is a rate increase family or responsible parties are always notified. Staff stated that R1’s POA was always late with the monthly payments. Licensee stated that the initial Admission Agreement was for $2600 but due to financial hardships that in 2024 a new admission agreement was made to reflect a lower amount of $1900 to help the family. LPA conducted a file review of monthly rent checks and it was revealed that in 2022 R1’s POA was paying $3100 when staff was asked to explain the discrepancy LPA was told that it was due to POA always being late the year prior, so they were making up the payments. LPA asked for documents to support this, and none could be provided. LPA also observed a written email signed by licensee that in April of 2023 R1’s monthly payment was $1940 but according to copies of checks provided in April of 2023 $3314 was paid to facility by POA. Licensee stated that R1’s condition had changed since he/she had first arrived at the facility and more services were needed. All staff indicated that R1’s POA was hard to get ahold of, and phone numbers provided were always changing. LPA could not obtain any document from facility that POA was notified of any rate increase.

In regard to the allegation” Staff are billing resident for services not rendered”, It is alleged that facility was billing R1 for a private room when in fact R1 was sharing a room. During interview with Administrator, Assistant Administrator, and Licensee and three (3) stated that resident initially had a single bedroom but because of changes to R1’s condition it was in R1’s best interest to be moved to bedroom in front so staff could keep an eye on resident. Licensee stated that R1’s condition had worsened and that POA was notified over the phone of the room change. It was also revealed that the reason for any rate increase was because more services were being provided. LPA asked to see documents of the change of condition of resident and Licensee was only able to provide appraisal needs and service plan for the years 2022, 2024, and 2025. LPA asked when room were changed and there was no documents indicating date. Licensee stated that appraisal needs and service plan are done every year but didn’t know why they were not in R1’s file to indicate the initial date of change of condition.

Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22 and Health and Safety Code. An exit interview was conducted, and a copy of this report was given to Caregiver.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 18-AS-20240112143536

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: VANDELON HOME CARE	FACILITY NUMBER: 336406385
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/19/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/01/2026 Section Cited HSC 1569.655	1 2 3 4 5 6 7	§1569.657 Rate increase due to change in level of resident care; notice (a) For any rate increase due to a change in the level of care of the resident, the licensee shall provide the resident and the resident’s representative, if any, written notice of the rate increase within two business days after initially providing services at the new level of care. The notice shall include a detailed explanation of the additional services to be provided at the new level of care and an accompanying itemization of the charges.	1 2 3 4 5 6 7	Licensee will draft a plan as to what needs to be done prior to a rate increase and send to LPA by POC due date. Licensee can not provide a refund to R1 or POA because R1 has since passed away and POA's phone is no longer in service.
	8 9 10 11 12 13 14	This requirement is not being met as evidenced by: LPA observed resident #1 rate was increased for the year 2022 and R1's family was not provided a written notifiaction of a rate increase due to a change in R1's condition.	8 9 10 11 12 13 14
Type B 05/01/2026 Section Cited CCR 87463(f)	1 2 3 4 5 6 7	87463 Reappraisals (f) The licensee shall immediately, or as soon as reasonably possible, communicate with the resident and, if applicable, the resident's representative, about any significant change in condition and the recommendation, if any, of the appropriate licensed medical professional, and if applicable, other specialized care provider. Documentation of such communication shall be added to the resident’s record.	1 2 3 4 5 6 7	Licensee will draft a plan to insure all residents appraisel needs and services are updated and send plan to LPA by POC due date. Licensee will insure all family members and responsible partys are notified when a change of condition is observed.
	8 9 10 11 12 13 14	This requirement is not being met as evidenced by: Licensee did not have R1's initail change of condition documented. Licensee could not provide documents that POA was notified of any additional services needed. R1 was moved from a private room to a shared room because of change of condition.	8 9 10 11 12 13 14

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: Tony Vasallo
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/12/2024 and conducted by Evaluator Christian Gutierrez

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20240112143536

FACILITY NAME:	VANDELON HOME CARE		FACILITY NUMBER:	336406385
ADMINISTRATOR:	MARK UY		FACILITY TYPE:	740
ADDRESS:	1024 HALSTEAD WAY		TELEPHONE:	(951) 765-6356
CITY:	HEMET	STATE: CA	ZIP CODE:	92545
CAPACITY:	6	CENSUS: 3	DATE:	04/19/2026
		UNANNOUNCED	TIME BEGAN:	09:28 AM
MET WITH:	Mark Uy		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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Staff did not provide resident a complete copy of the Admission Agreement

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2026

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

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 18-AS-20240112143536

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: VANDELON HOME CARE	FACILITY NUMBER: 336406385
	VISIT DATE: 04/19/2026

NARRATIVE

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In regard to the allegation” Staff did not provide resident a complete copy of the Admission Agreement.” It is alleged that R1’s POA never received a complete copy of Admission Agreement after several attempts to the facility. During interview with Administrator, Assistant Administrator, and Licensee all three (3) stated that an admission agreement is always given to residents and family. All three staff stated that they do not recall ever receiving a request for a copy of the agreement. Administrator stated that R1’s POA was very hard to get ahold of and that the phone was always not working. LPA obtained a completed copy of two admission agreements both signed by POA. LPA attempted to contact W1 but was unsuccessful due to the phone number provided being disconnected.

Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview was conducted, and a copy of this report was given to caregiver.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2026

LIC9099 (FAS) - (06/04)

Page: 5 of 5