Complaint·August 30, 2021

Continued from LIC 9099... LPA Valerio conducted interviews with the administrator and facility staff on 05/20/2021 and 06/26/2021. During the interviews, the Administrator Euforino and facility staff could not remember the exact dates of Resident 1 (R1) stay at Sunny Peace 1. Administrator Eurforino stated R1 was at the facility from 12/23/21 to 12/31/21. Facility medical records showed medications were given to R1 on dates 12/24/21 until the morning of 12/31/21. LPA Valerio reviewed the facility's Admission Agreement, section 9, discusses the Refund Policy. The refund policy states the following: A. The Agreement must indicate whether or not all, or any portion(s), of a payment will be refunded. There are no preadmission fees or deposits against damages being charged prior to the resident moving in or during the resident's stay. B. Refunds will be granted as follows: If the resident has to move for a higher level of care, a refund will be delivered within two weeks after all of the residents items have been removed. (See attached policies if the Department orders a relocation order or when the resident dies) C. If the resident leaves the facility temporarily, the holding rate for his/her room is $___ per day. The total monthly rate set forth in the admission agreement __ will _x_will not be prorated on a daily basis upon the resident's admission to, or permanent departure from, the facility during the month. H&S Code Section 1569.884 LPA Valerio reviewed American River Home Care medical records for R1, electronically signed on 01/02/2021. According to medical records, R1 was transferred to Kaiser South on 12/28/2021. According to RP, R1 was at the facility from 12/23/21 until 12/28/21. R1 did not return to the facility due to needing a higher level of care. The RP confirmed that they did not receive or complete discharge paperwork for R1. LPA Valerio attempted to review R1's inventory sheet to determine the length of time R1's belongings were in the facility. Administrators informed LPA Valerio an inventory sheet was not completed for R1. Continued on LIC 9099-C Page 3... Continued from Page 2 LIC 9099- C... The RP and Administrator of Sunny Peace 1 stated they communicated via phone regarding R1's hospital stay, admission agreement, and refund. LPA Valerio learned there were no documentation of alleged conversations. Based on LPA's interviews, medical record review, and facility record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED.  California Code of Regulations (Title 22, Division 6, Chapter 8) are being cited on the attached LIC 9099-D . Failure to correct the deficiency may result in civil penalties. Appeal rights were provided. An exit interview was held with Licensee Maria Carrasco and a copy of the report was left at the facility.