Complaint·April 1, 2026

[CONTINUED FROM LIC 9099] When R1 moved into the facility during August 2024, Licensee had assessed R1 as needing no staff assistance with either medications or care at that time. (In other words, R1 was charged only for room and board, but was not charged for either a medication level or a care level then). R1 had a responsible person (RP) other than themselves who signed R1's admissions agreement contract and acted as R1’s payee. (While the RP did later relinquish their role on 02/23/2026, the RP was still in force in this legal capacity throughout the time-period that is pertinent to this complaint.) California Health and Safety Code Section 1569.657 states: “(a) For any rate increase due to a change in the level of care of the resident, the licensee shall provide the resident and the resident’s representative, if any, written notice of the rate increase within two business days after initially providing services at the new level of care. The notice shall include a detailed explanation of the additional services to be provided at the new level of care and an accompanying itemization of the charges.” The burden of proof for timely service of such written notices falls to the Licensee. Per the official website of the United States Postal Service (USPS), First Class Mail (letters and cards) typically arrive in between one (1) to five (5) business days. On Thursday 02/13/2025, Licensee reassessed R1 and determined that R1 now needed facility staff to help R1 with storing and taking their prescribed medicines. R1 thus went from no medication level ($0) to Medication Level 1 ($500 per month), effective 02/13/2025 and continuing through present. Per facility manager Staff #1 (S1), they phoned R1’s RP around this time asking to discuss the change but the RP did not answer; S1 left the RP a voicemail, which was not returned. S1 did not discuss fee/cost changes in their voicemail. Per HSC 1569.657(a), written notice of this change in R1’s medication level (and accompanying change in fee) was required to be served to the RP no later than Friday 02/14/2025. However, the written notice of such was first authored and put in outgoing mail (non-certified) by facility manager Staff #2 (S2) on Sunday 02/16/2025 (as confirmed by both the printed date on the letter and interview of S2). This letter was thus picked up by USPS no sooner than Monday 02/17/2025. Per a conservative estimate, this letter would have arrived at the RP’s mailing address at the latest by Friday 02/21/2025, seven (7) days after the service due date. The preponderance of evidence shows that there were up to seven (7) days when R1 was billed for Med Level 1 (up from no med level) without the required legal notice to the RP. [CONTINUED FROM LIC 9099-C, 2 of 3] [CONTINUED FROM LIC 9099-C, 1 of 3] On Sunday 03/02/2025, Licensee reassessed R1 and determined that R1 now needed facility staff to help with personal care, at least temporarily. R1 thus went from no care level ($0) to Care Level 2 ($1,460 per month), effective 03/03/2025. Per S1, they phoned R1’s RP around this time asking to discuss the change but the RP did not answer; S1 left the RP a voicemail, which was not returned. S1 did not discuss fee/cost changes in their voicemail. Per HSC 1569.657(a), written notice of this change in R1’s care level (and accompanying change in fee) was required to be served to the RP no later than Tuesday 03/04/2025. The written notice of such was first authored and put in outgoing mail (non-certified) by S2 on Monday 03/03/2025 (as confirmed by both the printed date on the letter and interview of S2). Per a conservative estimate, this letter would have arrived at the RP’s mailing address at the latest by Friday 03/07/2025, three (3) days after the service due date. The preponderance of evidence shows that there were up to three (3) days when R1 was billed for Care Level 2 (up from no care level) without the required legal notice to the RP. R1’s Care Level 2 was billed only through 04/08/2025, because Licensee subsequently reassessed R1 and put them back on no care level, again. On Thursday 12/11/2025, Licensee reassessed R1 and determined that R1 again needed facility staff to help with personal care. R1 thus went from no care level ($0) to Care Level 1 ($730 per month), effective 12/11/2025 and continuing through present. Per S1, they phoned R1’s RP around this time to discuss the change but the RP did not answer; S1 left the RP a voicemail, which was not returned. S1 did not discuss fee/cost changes in their voicemail. This time around, S1 also sent the RP a follow up E-mail, but did not discuss fee/cost changes in said E-mail, either. Per HSC 1569.657(a), written notice of this change in R1’s care level (and accompanying change in fee) was required to be served to the RP no later than Friday 12/12/2025. However, the written notice of such was first authored and put in outgoing mail (non-certified) by S2 on Sunday 12/14/2025 (as confirmed by both the printed date on the letter and interview of S2). This letter was thus picked up by USPS no sooner than Monday 02/15/2025. Per a conservative estimate, this letter would have arrived at the RP’s mailing address at the latest by Friday 12/19/2025, seven (7) days after the service due date. The preponderance of evidence shows that there were up to seven (7) days when R1 was billed for Care Level 1 (up from no care level) without the required legal notice to the RP. [CONTINUED ON LIC 9099-C, 3 of 3] [CONTINUED FROM LIC 9099-C, 2 of 3] Based on records and interviews, a preponderance of evidence exists to show that Licensee did not meet notification requirements regarding increases in R1’s care levels. The allegation is therefore Substantiated, and one (1) deficiency was cited for it per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D page). A Plan of Correction was jointly developed with the Licensee. An exit interview was conducted with Community Business Director Patricia “Kitty” Totorica, to whom a copy of this report, the LIC 9099-D page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.