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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347001629
Report Date: 04/13/2021
Date Signed: 04/13/2021 02:02:52 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/12/2020 and conducted by Evaluator Michael Hood
COMPLAINT CONTROL NUMBER: 27-AS-20200812111333
FACILITY NAME:MARIA'S HOME CAREFACILITY NUMBER:
347001629
ADMINISTRATOR:ANDREI COSTEAFACILITY TYPE:
740
ADDRESS:5914 CANARY DRIVETELEPHONE:
(916) 344-5487
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY:6CENSUS: 2DATE:
04/13/2021
UNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Andrei Costea, LicenseeTIME COMPLETED:
01:20 PM
ALLEGATION(S):
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Financial Abuse
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Michael Hood contacted Licensee, Andrei Costea, via telephone to deliver findings for a complaint investigation of violation of financial abuse. This visit was conducted via telephone due to COVID-19 and precautionary measures.

On 10/30/2020, LPA contacted a representative of Sierra Fiduciary, who was the payee for resident R1 during their stay at facility Maria’s Home Care. Representative stated that they paid R1’s rent to placement agency, Peppermint Palm Placement Services, per a contract agreed upon by the payee and the placement agency. The placement agency would then forward the facility’s share of the money to the facility that R1 was residing.

** Report continued on 9099-C **
Unfounded
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Anthony Perez
NAME OF LICENSING PROGRAM ANALYST: Michael Hood
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2021
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 2
Control Number 27-AS-20200812111333
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: MARIA'S HOME CARE
FACILITY NUMBER: 347001629
VISIT DATE: 04/13/2021
NARRATIVE
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LPA reviewed Licensee’s contract with Peppermint Palm Placement Services, along with R1’s Admission Agreement. R1’s Admission Agreement states that “all payments to home will be from Peppermint Palm Senior Care” and that rate for basic services was “per contract.” Based on interview with payee and Licensee, as well as review of contract from placement agency, all financial transactions were conducted in accordance with agreement between payee, placement agency, and facility.

Based on interviews conducted by LPA and records reviewed, the above allegation is found to be UNFOUNDED. A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Exit interview was conducted with Licensee via telephone and a copy of this report will be provided to the facility via email. This facility shall sign and return a copy of the report to the department and print a copy to be retained by the facility.
NAME OF LICENSING PROGRAM MANAGER: Anthony Perez
NAME OF LICENSING PROGRAM ANALYST: Michael Hood
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2