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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604442
Report Date: 06/18/2024
Date Signed: 06/18/2024 12:41:01 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/12/2024 and conducted by Evaluator Renita Hall
COMPLAINT CONTROL NUMBER: 08-AS-20240612162203
FACILITY NAME:RENAISSANCE LIVING IIIFACILITY NUMBER:
374604442
ADMINISTRATOR:EDWARDS, RICHARDFACILITY TYPE:
740
ADDRESS:423 AVOCADO AVETELEPHONE:
(619) 954-0963
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY:6CENSUS: 6DATE:
06/18/2024
UNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Richard Edwards, LicenseeTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Licensee did not provide refund to resident's responsible party
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Renita Hall conducted an unannounced visit to open a complaint and deliver findings. LPA was allowed entry by Richard Edwards, Licensee. LPA identified herself disclosed the purpose of the visit, and shared findings with the Licensee.

On June 12, 2024, the Department received a complaint that the Licensee had not refunded the responsible party after Resident 1 (R1) 's death in May 2024. R1 lived at the facility for 3 days from May 13, 2024, to May 15, 2024, and passed away on May 15, 2024.

On June 18, 2024, the Department investigated the above-listed complaint allegation. The investigation consisted of a tour of the facility an interview with the Licensee and a review of records.

Continued 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
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 3
Control Number 08-AS-20240612162203
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: RENAISSANCE LIVING III
FACILITY NUMBER: 374604442
VISIT DATE: 06/18/2024
NARRATIVE
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Review of records showed on page 12 of the admission agreement "Death of resident", "within fifteen (15) days after your personal property is removed from the facility, your estate, or other person or entity responsible for payment of fee and charges under this Agreement, will receive a refund of any fee paid in advance covering the period after the personal property has been removed." The family removed R1's belongings from the facility on May 15, 2024. The responsible party asked the Licensee for a refund and was told that a refund would be given within 15 days. After 15 days, the responsible party had not received a refund.

The Licensee stated that he misunderstood the regulation and that by charging a flat fee for all costs a refund would not be given. The flat fee cost also included payment to the placement agency. The regulation for refunds after the death of a resident is 15 days.

Based on the evidence obtained during the complaint investigation, the allegation that Licensee did not provide a refund to the resident's responsible party was found to be SUBSTANTIATED, as there is a preponderance of evidence to prove the alleged violation occurred.

An exit interview was conducted; a copy of this report along with Licensee Appeal Rights LIC 9058 (REV 3/22) were provided to the Licensee and his signature confirms receipt of these documents.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20240612162203
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: RENAISSANCE LIVING III
FACILITY NUMBER: 374604442
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/25/2024
Section Cited
HSC
1569.652(c)
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(c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility or entity contractually responsible to.... the resident’s estate, within 15 days after the personal property is removed.
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Review section Health and Safety Code1569.652 (c) and make refund payment to responsible party bay June 25, 2024.
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This requirement was not met as evidenced by: Based upon interviews, records reviewed. The licensee did not provide refund timely to the responsible party after the death of resident.
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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: Denise Powell
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
LIC9099 (FAS) - (06/04)
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