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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425850365
Report Date: 05/30/2025
Date Signed: 05/30/2025 11:16:07 AM

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
04/25/2025 and conducted by Evaluator Mark Jeffries
COMPLAINT CONTROL NUMBER: 29-AS-20250425142414
FACILITY NAME:FOUNTAIN SQUARE OF LOMPOCFACILITY NUMBER:
425850365
ADMINISTRATOR:MURRAY, ROBINFACILITY TYPE:
740
ADDRESS:1420 W NORTH AVENUETELEPHONE:
(805) 736-1234
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:130CENSUS: 59DATE:
05/30/2025
UNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Administrator, Robin MurrayTIME COMPLETED:
11:57 AM
ALLEGATION(S):
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Staff did not prevent resident from being financially exploited.

Staff did not safeguard resident's personal belongings.
INVESTIGATION FINDINGS:
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 At 8:20am on 05/30/2025, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to issue final finding to the allegations to this complaint. LPA met with facility Resident Care Coordinator (RCC) Verinoca Guinea at 8:36am, announced he he is and reason for the visit. RCC called Administrator, Robin Murray and Administrator arrived at 8:50am. LPA Hanner-Tommasko arrived at 9:15am to address a seperate complaint and final findins on a sperate report. LPA deliverd the final findings to RCC and Resident Care Supervisor, Noemi Jimenez (RCS).
As to the allegation of, “Staff did not prevent resident from being financially exploited.” and “Staff did not safeguard resident's personal belongings.” It was alleged that, sometime during the months October and November of 2024, Resident 1’s (R1) Medicare Card went missing from R1’s wallet, furthermore, R1’s hearing aids and cell phone went missing by the month of February 2025. Additionally, R1 was fraudulently charged for 12 unauthorized physical therapy sessions, charged from 12/09/2024 through 01/04/2025, that did not take place.
CONTINUED on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2025
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 4
Control Number 29-AS-20250425142414
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: FOUNTAIN SQUARE OF LOMPOC
FACILITY NUMBER: 425850365
VISIT DATE: 05/30/2025
NARRATIVE
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 It was discovered in an interview with Facility Administrator, Robin Murray, on 04/30/2025, and email on 05/05/2025, that she had recalled, “Approximately in late November 2024, Mr. Grover, (Chris Grover, PT) came into the community and introduced stating that he worked next door (Lompoc Skilled Nursing & Rehabilitation [SNF]) and wanted to know if we (Fountain Square) had anyone who needed outpatient Therapy services. Administrator also stated that, Mr. Grover was introduced to the facility, Resident Care Coordinator (RCC), and was informed to always check in with the RCC as many family members are the Resident's decision makers. Administrator also stated, “one encounter, I was informed from my staff that he was only seen a couple of times, and for less than a five-minute period. One time I saw him walk in and looked for him and he had already left the community.” Administrator stated that they communicated with the Skilled Nursing Facility (SNF) next door as to PT being conducted by Chris Grover and it was determined that Mr. Grover was not an employee of the SNF, but a per Diem therapist. Administrator stated that they made a phone call to Chris Grover (date unknown, during the month of February 2025), telling him, “I told him we have no vendor contract with him, there is no solicitation in our community or generally in ALs as well, and that he is not allowed in the community.” On 05/02/2025 and again on 05/09/2025 Licensing Program Analyst Jeffries (LPA) reviewed all facility resident and visitor sign in logs dating from November 15, 2024, through January 20, 2025, provided by email on 05/05/2025 by Administrator, and noted that there were zero sign-ins by Chris Grover during that time period. LPA also noted that all visitor sign-ins to see R1 were all sign-ins by family members of R1 with no other noted visitors for R1 on the facility sign in logs during that time period. On 05/29/2025 LPA contacted Administrator by phone to confirm that all sign-in by the name “Chris” or “Christopher” were not Chris Grover, this was confirmed by email on same day. LPA Jeffries reviewed R1’s medical billing from December 9, 2024, though January 4, 2025, with 12 physical therapy visits billed to R1 resulting in a total of $5732.19; $2215.60 paid to Chris Grover; $2956.92 paid by insurance companies; and $559.67 paid as a co-pay fee. LPA noted that these invoices indicated that they were authorized by Doctor #1, who is R1 attending Physician. On 04/30/2025 LPA Jeffries conducted an interview with R1 Power of Attorney (W1) who stated that they had contacted Doctor #1’s office to determine if there was an authorization for Physical Therapy Services. W1 stated that Doctor #1’s office denied authorizing PT referral and had no documentation indicating those PT services were authorized through Doctor #1’s office. W1 state that they did not know who Chris Grover was, and as POA to R1 did not authorize him to conduct PT services at any time.

CONTINUED on LIC9099-C
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20250425142414
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: FOUNTAIN SQUARE OF LOMPOC
FACILITY NUMBER: 425850365
VISIT DATE: 05/30/2025
NARRATIVE
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 W1 stated that they do not know how Chris Grover knew who R1’s Primary Care Physician was but suspected that the missing Medicare card, and Administrator stating to W1 that Chris Grover had been seen coming out of R1’s room. W1 stated that R1 receives PT through the Veterans Affairs Office (VA) outside of the facility. On 05/29/2025, LPA Jeffries conducted a phone interview with Resident 2 (R2) family member (W2) and POA of R2, who stated that, Chris Grover billed R2 for 13 sessions of PT that were unauthorized. W2 stated that they called R2’s primary care physician, Doctor #2, who was listed as the referring Physician, who stated they did not authorize any PT session to Chris Grover. W2 stated that the facility helped them dispute the charges but as of 05/29/2025 have not received any verification if those charges were refunded. W2 stated that they did know Chris Grover and did not authorize him to provided PT services to R2 at any time. W2 stated that they did not know Chris Grover and not know how he knew personal or medical information of R2. W2 stated that Chris Grover did speak with R2 briefly in the facility but did not know or recall what information was shared. LPA observed facility communication record to Doctor #2, dated 04/30/2025 requesting PT referral for R2, with a response of, “Do not have a record of this.” LPA noted that two residents (R1 and R2) both have a diagnosis of cognitive impairment and have different primary physicians. On 03/17/2025, at 4:00pm, 04/03/2025 at 12:15pm, and 04/30/2025 at 9:00am LPA Jeffries entered the facility unscreened by staff, and had to walk the halls of the facility to find staff in order to check into the facility.
Based on, interviews, observations, documentation of facility log-in records that had no record of sign-in of Chris Glover, in which his presence at the facility was confirmed by Administrator statements and emails, observations of LPA on 3 facility visits of no staff to screen who is entering or exiting the facility, documentation of fraudulent bills for R1 and R2, and documentation of different residents detailed medical information in flatulent billing invoices. Due to lack of staff screening the entrance to the facility, reasonable efforts to safeguard resident property (and medical information) were not made and therefore, there is enough evidence at this time to support the allegations of “Staff did not prevent resident from being financially exploited.” and “Staff did not safeguard resident's personal belongings.” and are both substantiated at this time.

Exit interview, report read, citations issued, appeal rights and report provided.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 29-AS-20250425142414
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: FOUNTAIN SQUARE OF LOMPOC
FACILITY NUMBER: 425850365
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/13/2025
Section Cited
CCR
87218(a)(2)
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87218 Theft and Loss (a) The licensee shall ensure an adequate theft and loss program...(2) A licensee who fails to make reasonable efforts to safeguard resident property,... The licensee shall be presumed to have made reasonable efforts to safeguard resident property if there is clear and
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Administrator will start the recruting and hiering process for a front desk receptionist to help with screening residents, vendors, and visitors.
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convincing evidence of efforts to meet each requirement specified in Section 1569.153. This requirement was not met by evidence of lack of screening of uncleared staff and vendors, which puts residents in potential danger.
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Type B
06/13/2025
Section Cited
CCR
87468.2(a)(25)
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities
(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:
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Administrator argrees to have a one hour training for all staff on personal rights and safeguarding residents property and information.
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(25) To protection of their property from theft or loss according to Health and Safety Code ... This requirement was not met by evidence of several missing property items of Resident 1, which poses a potential risk to 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: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4