Complaint·May 16, 2024

(ED1-S1) claimed the facility was always in assistance to assist with (R1)’s medical care. (ED1) denied ever communicating to (R1) that the facility was in the process of transferring (R1) to another facility once the insurance matter was resolved. On 05/16/24, between 10:44 am – 11:55 am, the Department interviewed (9) out of (9) residents #2 - #10 (R2-R10) who were complimentary of staff. (R2-R10) expressed the staff is responsive and attentive in assisting with medical care appointments. (R2-R10) indicated they are truly happy living at the facility and the services the care staff provided. As a result of the Department reviewing (R1)'s Physician Report LIC 602A (dated: 08/11/23) and Pre-Preplacement Appraisal Information LIC 603A (dated: 09/22/23) it was discovered that (R1) is in good physical status, can self-care, and is in a safe mental state. Based on the information gathered, there is no sufficient evidence to corroborate the allegation mentioned above. Based on the information collected, an inspection of the facility, observation and interviews conducted, and an analysis of records reviewed, the Department found no evidence to support the allegation mentioned in this complaint. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is Unsubstantiated. No deficiencies were cited. An exit interview is conducted with Mendy Ginsberg and a copy of the report is provided. INVESTIGATION REVEALED THE FOLLOWING: Allegation #1: Licensee does not assist resident with arranging medical care. The details of the complaint alleged that facility staff failed to assist resident #1 (R1) in arranging an appointment to see a medical doctor for posterior capsule opacification. The complainant claimed the licensee stated that the facility cannot meet (R1)’s needs and is waiting for insurance to be handled and that (R1) will be transferred to another facility. The complainant did not provide further details on the matter. According to resident #1 (R1)’s Residence and Care Agreement (dated: 08/03/23), (R1) was admitted at City View on 09/22/23. On 05/16/24, between 01:23 pm – 01:37 pm, the Department interviewed resident #1 (R1). (R1) who is currently not at the facility was interviewed by telephone. (R1) claimed that facility staff did not refuse to assist (R1) in making the medical appointment, it was the process that was frustrating in getting an appointment. (R1) confirmed that (R1) was with a Health Maintenance Organization (HMO) insurance carrier and that (R1)'s preferred medical doctor was not a participant in the HMO contract. (R1) understood that (R1) required to change medical insurance carrier to be seen by (R1)’s preferred physician and that it indeed has taken a long process. Otherwise, (R1) claimed that everything is satisfactory with the facility staff at City View. (R1) stated that this matter has been resolved. On 05/16/24, between 10:29 am – 12:10 pm, the Department interviewed Regional Executive Director #1 (ED1) and Wellness Director Staff #1 (S1). (ED1 and S1) both denied this allegation. A few months ago, (R1) approached (S1) about making a medical appointment for posterior capsule opacification for (R1). (R1) enrolled in CareMore Medical Group (HMO) when (R1) was admitted at City View was signed to this medical plan by a CareMore representative in September 2022. The result of signing with CareMore (HMO), (R1)’s primary care physician is not a participant provider in this plan. (R1) preferred (R1)'s primary physician and that meant having to terminate with CareMore (HMO) and enroll with California Medicaid Health Program to have access to (R1)’s preferred primary medical physician. (S1) reported that (R1) did not understand the process and wanted the issue to be resolved instantly. (S1) explained that there is a process. (S1) claimed effective 04/30/24, (R1) terminated medical insurance coverage with CareMore (HMO), and effective 05/01/24, (R1) was enrolled with California Medicaid Health Program. (Evaluation Report continues LIC9099-C)