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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405802285
Report Date: 04/08/2021
Date Signed: 04/08/2021 04:51:27 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/09/2021 and conducted by Evaluator Rachael De Leon
COMPLAINT CONTROL NUMBER: 29-AS-20210309110546
FACILITY NAME:ROSE GARDENFACILITY NUMBER:
405802285
ADMINISTRATOR:DIANA BARNHILLFACILITY TYPE:
740
ADDRESS:6100 LOS GATOS ROADTELEPHONE:
(805) 466-2506
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY:6CENSUS: 3DATE:
04/08/2021
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Diana Barnhill, Licensee/AdministratorTIME COMPLETED:
04:50 PM
ALLEGATION(S):
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Administrator refused to issue a proper refund
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) De Leon conducted a subsequent complaint visit to the facility. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically/virtually with Licensee Diana Barnhill. LPA explained the purpose of today’s visit was to deliver final findings of the complaint investigation.

On the allegation: Administrator refused to issue a proper refund, LPA conducted interviews on 03/12/2021 with Licensee, on 03/09/2021 with Witness 1 (W1) and collected documentation. Documentation was reviewed on 03/06/2021 and 03/16/2021 and revealed a signed Admission Agreement (AA) between the parties and it does state under Death of a Resident: …Within fifteen (15) days after your personal property is removed a refund would be issued for any fees paid in advance covering the period after (Cont.9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2021
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 3
Control Number 29-AS-20210309110546
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ROSE GARDEN
FACILITY NUMBER: 405802285
VISIT DATE: 04/08/2021
NARRATIVE
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your personal property has been removed. The Licensee failed to issue a refund during this time period.
The AA states a pre-admission fee of $1500.00 is to be paid and was refundable, listings the conditions for the refund. According to the AA the Responsible Party (RP) meets the following condition for refund: Proportional refunds of pre-admission fees in excess of $500 are given according to the following: (d.) 40% if a resident leaves the facility during the third month. This refund has not been issued to the RP at this time and is due according to the terms in the AA agreement.

In the AA it is stated the Licensee shall, within three days of becoming aware of the resident’s death, provide written notice of the facility’s policies regarding contract termination at death and refunds, which is required by regulation. Resident 1 (R1) passed away on 10/06/2020 and all but two items were removed on that day. Licensee stated to R1’s RP in a text conversation on 10/06/2020 at 1818 hours, “…There’s no hurry to move your mom’s things…” not mentioning anything about refunds. The RP arranged for the last two items to be picked up on 10/18/2021, not realizing the estate would pay for those extra days. The refund is due from the date of R1’s death which is the day the bulk of R1’s personal property was removed on 10/06/2020 and no written notification was given to RP.

Evidence shows a refund was issued late on 01/15/2021 to R1’s RP for $2196.78 with a statement it was for refund of rent from October 18th -31st , 2020 and $100 for unused incidentals. The Licensee still owes an additional refund for rent and pre-admission fee to the RP. Therefore, this allegation is deemed Substantiated this time.

An additional refund will need to be issued to R1’s RP for the remainder of the monies owed. The refund of rent from October 7-31, 2020 at $161.29 per day for 25 days total $4,032.85, $100 October incidentals, $400 for the refund of pre-admission fees, for a total of $4523.85 minus the payment already made to the RP on 01/15/21 for $2196.78 would leave a balance owed to RP of $2,336.07 to be refunded by Licensee.

Exit interview conducted, deficiencies cited, copy of report and appeal rights emailed to Licensee to sign and return to the Goleta office by mail.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20210309110546
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ROSE GARDEN
FACILITY NUMBER: 405802285
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/08/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/15/2021
Section Cited
HSC
1569.652(d)
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...(d)... a licensee shall, within three days of becoming aware of the resident’s death...written notice of the facility’s policies...and refunds. This requirement was not met as evidenced by:
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Licensee agreed to issue a refund from 10/07/2020 to 10/31/2020 for fees that had been paid prior to death of R1 for not issuing the required written notice to RP, minus the refund already provided to RP.
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Based on documentation the Licensee did not comply with R1’s admission agreement to provide written communication regarding refunds which poses a potential personal rights risk to residents.
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Type B
04/15/2021
Section Cited
CCR
87507(g)(5)(E)(2)(c)
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...c. A refund of at least 40 percent of the preadmission fee in excess of $500...during the third month of residency. This requirement was not met as evidenced by:
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Licensee agreed to issue a refund for $400 which is 40% of pre-admission fee due to the RP as R1 passed away during her 3rd month at the facility.
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Based on documentation the Licensee did not comply with the AA and did not issue a refund of 40% of the pre-admission to the RP which poses a potential personal rights risk to the residents in care.
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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: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3