567609831-7-29-2022-29-AS-JAPL-CGVNXA-20220801105045

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 567609831
Report Date: 07/29/2022
Date Signed: 07/29/2022 01:40:41 PM

Unsubstantiated

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
02/25/2022 and conducted by Evaluator Ashley Smith

COMPLAINT CONTROL NUMBER: 29-AS-20220225110618

FACILITY NAME:	ROYAL OAKS INN		FACILITY NUMBER:	567609831
ADMINISTRATOR:	JAKOBOVICH, BRANDON		FACILITY TYPE:	740
ADDRESS:	45 ERBES RD		TELEPHONE:	(805) 495-4657
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91362
CAPACITY:	80	CENSUS: 61	DATE:	07/29/2022
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Brandon Jakobovich		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Facility is inappropriately referring residents to a hospice service.
Facility is inappropriately billing residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ashley Smith arrived unannounced for a subsequent visit. The LPA met with Administrator Brandon Jakobovich and explained the reason for the visit.

During the initial visit conducted on 3/2/2022, the LPA interviewed three staff between 10:50 a.m. - 11:30 a.m., and requested pertinent documents. An additional staff interview was conducted on 07/08/2022 at 10:49 a.m. On 7/13/2022, the LPA interviewed family members of residents whom receive hospice services from 1:00 p.m. – 3:00 p.m. Additional interviews with family members of residents whom receive hospice services were conducted on 7/15/2022 at 10:30 a.m.; on 7/20/2022 at 11:09 a.m., 12:24 p.m., and 5:10 p.m.; and, on 7/22/2022 at 11:29 a.m.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022

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-20220225110618

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: ROYAL OAKS INN	FACILITY NUMBER: 567609831
	VISIT DATE: 07/29/2022

NARRATIVE

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Regarding the allegation: Facility is inappropriately referring residents to a hospice service.

It was alleged that the facility regularly accepts patients that are not at ‘end of life’ and refers them to receive hospice care so that the facility can receive a higher payment. As of 7/29/2022, out of 61 residents that reside at the facility, only 16 residents are receiving hospice services at this time. The facility has an approved hospice waiver to have up to twenty (20) residents on hospice at one time. It was communicated that some residents have lived at the facility for an extended period of time and due to a natural decline, were recommended to receive hospice services by their primary care physician. Staff said that residents can also be admitted to the facility with hospice care. Staff confirmed that they are unable to refer a resident to receive hospice services, as they are not medical professionals and that decision is to be made in collaboration with the resident’s responsible party and the prescribing medical professional providing care for the resident. Interviews with family members of residents whom receive hospice services confirmed that the resident was referred to hospice by either the resident’s primary care physician or admitting physician in the hospital, and that it was not the decision of the facility administration.

This facility has an in-house hospice agency named Spirit Healthcare Hospice. However, further review confirmed that this facility provides family members with a form entitled “Hospice Agency Informed Choice”, which is a list of available local hospice agencies to aid in the family’s choice in choosing the best fit for the resident in question. Family interviews confirmed that they were never persuaded or forced to choose the facility’s internal hospice company. A review of the list revealed that there are at least ten (10) listed hospice companies listed on the form. A review of the resident roster confirmed that there are currently at least four (4) different hospice agencies providing hospice services to residents in this facility.

Based on the information obtained, there is insufficient evidence to support the claim that the facility is inappropriately referring residents to a hospice service. This allegation is Unsubstantiated at this time.

Regarding the allegation: Facility is inappropriately billing residents.

It is alleged that once a resident is placed on hospice, the facility will accept or require an additional fee from the resident’s family ‘off the books’. Interviews confirmed that the board and care rate for residing at this facility is a standard rate, and the rate does not increase if a resident is placed on hospice. The facility stated that the board and care rate covers the basic services for the resident, and is separate from hospice care, as that is billed and covered through Medicare.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20220225110618

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: ROYAL OAKS INN	FACILITY NUMBER: 567609831
	VISIT DATE: 07/29/2022

NARRATIVE

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Staff reiterated that they do not require an extra charge or an increase in rate due to a higher level of care for any resident receiving hospice care. Staff denied claims that they ever received any cash payments or supplementary payments from families. Interviews with family members of residents whom currently receive hospice services confirmed that the facility did not increase the resident’s rate once the resident was placed on hospice, and denied claims that the facility has asked for any additional payment ‘off the record’.

Based on the information obtained, there is insufficient evidence to support the claim that the facility is inappropriately billing residents. This allegation is Unsubstantiated at this time.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022

LIC9099 (FAS) - (06/04)

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