Complaint·July 20, 2020

Continued from previous page LIC9099A On 5/9/2021, LPA Weathersby interviewed S1, S2,who denied hitting or witnessing anyone hit R1. LPA Weathersby also interviewed R2, who denied ever being hit or witnesses other residents being hit while residing in the facility. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegation occurred, therefore the allegation is Unsubstantiated . LPA Weathersby conducted an exit interview with Cecelia Barna and a copy of this report was provided to her. Continued from previous page LIC9099 The investigation consisted of the following: LPA Parker conducted interviews with the administrator, witness #1, staff #1, and LPA reviewed a preadmission fee explanation page. The investigation revealed the following: Resident #1 moved into Autumn Hill in February 2020. In April 2020, resident #1's family paid the resident's rent for 4/13/20 through 5/12/20. Resident #1 passed away on 4/15/20. After resident #1 passed away, the administrator did not give the resident's family a refund. The family was told there was no refund, based on a Preadmission Fee Explanation which the family signed. LPA reviewed the Preadmission Fee Explanation page, but this document was not an Admission Agreement. The family of resident #1 said they never signed an admission agreement, and the administrator could not produce an admission agreement. LPA explained to Cecelia Barna that she could not withhold the refund because she did not complete an admission agreement with resident #1's family, and the family was not aware of the facility's refund policy. LPA Parker spoke with Cecelia Barna on 7/20/20 and she agreed she would send the required refund to the family of resident #1. Based on the preponderance of evidence standard, the allegation is Substantiated . California Code of Regulations, Title 22, Division 6, Chapter 8 is cited on the attached LIC 9099D. LPA Weathersby commenced an unannounced in-person visit with Administrator, Cecelia Barna, LPA reviewed Allegation #1 with the Administrator, an exit interview was conducted and a copy of this report was provided to her.