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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 372004630
Report Date: 12/16/2024
Date Signed: 12/16/2024 11:41:46 AM

Unsubstantiated


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
08/14/2024 and conducted by Evaluator Janette Romero
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240814162626
FACILITY NAME:COUNTRY CLUB GUEST HOMEFACILITY NUMBER:
372004630
ADMINISTRATOR:RAMIREZ, JULIEFACILITY TYPE:
740
ADDRESS:25533 RUA MICHELLETELEPHONE:
(760) 747-0957
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY:30CENSUS: 27DATE:
12/16/2024
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Caregiver, Victoria MatthewsTIME COMPLETED:
11:50 AM
ALLEGATION(S):
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Facility staff are financially abusing resident
INVESTIGATION FINDINGS:
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On 12/16/2024, Licensing Program Analyst (LPA), Janette Romero arrived unannounced to deliver investigative findings regarding the allegation listed above. LPA met with Caregiver, Victoria Matthews who was informed of the purpose of the visit. Licensee, Julie Ramirez was contacted over the phone and also informed of the purpose of the visit.

It was alleged Staff 1 (S1) accompanied Resident 1 (R1) to the bank to withdraw $5,000.00 in July 2024 to pay their rent balance and R1 may be getting financially abused by the facility. LPA reviewed R1's Physician Report (LIC602A) dated 8/17/2023, which indicates R1 does not have the capacity to manage their own cash resources. LPA reviewed R1's admission agreement dated 3/1/2015 noting R1 is responsible for themselves, and the facility will maintain and supervise R1's cash resources.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
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 2
Control Number 18-AS-20240814162626
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: COUNTRY CLUB GUEST HOME
FACILITY NUMBER: 372004630
VISIT DATE: 12/16/2024
NARRATIVE
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The admission agreement also notes R1 pays the standard Supplemental Security Income monthly rate for basic services which is currently $1,398.07. S1 was interviewed and reported they safeguard R1’s checkbook in the staff office and R1 writes their own checks. S1 explained R1 pays their monthly rent using paper checks and ran out of checks in May 2024, which resulted in R1 not paying their rent for three (3) months. S1 explained the facility did not realize R1 had not paid their rent until July 2024. S1 reported they informed R1 and R1 requested S1 accompany them to the bank to withdraw money to pay the rent in cash. S1 reported R1 withdrew money and paid the rent balance in cash. R1 was interviewed and corroborated the information provided by S1 and reported they withdrew more than the rent owed, paid the rent balance to the facility in cash, and kept the remaining money on their person, which they recall was approximately $240.00. R1 reported they do not have a reason to suspect S1 or any other facility staff are financially abusing them and did not express any concerns with the care and supervision they currently receive at the facility. LPA reviewed R1’s bank statements noting $4,420.00 was withdrawn on 7/3/2024. LPA conducted a record review and noted the facility documented R1 withdrew cash and paid the rent balance on 7/3/2024. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is Unsubstantiated. An exit interview was conducted and this report was reviewed with Licensee Ramirez over the phone and a copy of this report was provided to Caregiver Matthews along wiht a Confidential Names list (LIC 811).
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2