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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880860
Report Date: 08/12/2021
Date Signed: 08/12/2021 04:06:17 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, 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
08/10/2021 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210810084426
FACILITY NAME:ALPHALIFE HOMECAREFACILITY NUMBER:
361880860
ADMINISTRATOR:SALDIVAR, BRYANT JFACILITY TYPE:
740
ADDRESS:9154 BELLFAST ROADTELEPHONE:
(909) 601-5154
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92308
CAPACITY:12CENSUS: 4DATE:
08/12/2021
UNANNOUNCEDTIME BEGAN:
01:27 PM
MET WITH:Administrator Bryant Salidvar & Caregiver Yanira SalvidarTIME COMPLETED:
04:25 PM
ALLEGATION(S):
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Applicant was not refunded preadmission fee.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to commence a complaint investigation and to deliver findings for the allegation listed above. LPA was greeted and granted entry by caregiver Yanira Saldivar. Administrator was unavailable to come to the facility, but was available by telephone. LPA explained the purpose of the visit and discussed the elements of the allegation with the administrator. The investigation consisted of observation, interviews, and a review of pertinent documents.

Allegation: Applicant was not refunded preadmission fee.
Administrator stated during the interview that there was a signed agreement that anything above $500 was to be refunded, however due to having to go out to the home to conduct the preadmission appraisal assessment took 4 different trips from Apple Valley to Rialto. Having to pick up the applicant to take them to tour the facility, take the applicant back home, and for the Administrator to then drive back home. Administrator stated that they have a signed agreement outlining the conditions in which the preadmission fee would be refunded.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021
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 18-AS-20210810084426
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ALPHALIFE HOMECARE
FACILITY NUMBER: 361880860
VISIT DATE: 08/12/2021
NARRATIVE
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The applicant did confirm that they were in fact picked up and went to a fast food place to sign a bunch of paperwork, and provided copies of the completed pre appraisal assessment, as well as a signed and dated copy of the Application Fee/preadmission procedure.

LPA reviewed the application/processing fee for the applicant as well as resident # 2 and # and it states the reasons for the $500 fee, which includes the resident appraisal. Under conditions for Preadmission refund: 1. If the applicant decides to not to enter the facility prior to the facility's completion of the preadmission appraisal or if the facility fails to provide full written disclosure of the preadmission fee changes and refund conditions..."

Based on observation, interview and record review the allegation of Applicant was not refunded preadmission fee is UNFOUNDED. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

An exit interview was conducted and a copy of this report, and appeal rights were provided to Caregiver Yanira Saldivar.


SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2