Vandelon Home Care

Allegation investigated: Staff did not give resident sufficient notice of rate increase Staff are billing resident for services not rendered

Licensing Program Analyst (LPA) Christian Gutierrez conducted a subsequent complain visit in regard to the allegations listed above. LPA met with Administrator Mark Uy, Assistant Administrator Marlon Uy, and Licensee Haide Uy explained reason for visit. The investigation consisted of the following: During the initial visit conducted on 01/19/2024, LPA Chinwe Nwogene conducted an unannounced visit for the purpose of investigating the above allegation. LPA toured the facility, interviewed staff and reviewed resident file During today’s visit LPA Gutierrez obtained copies of the following documents: R1’s physician report, healthcare notes from 2017, appraisal needs and service plan for 2022,2024, and 2025, rate plan for 2023, Identification and emergency information, two admission agreements, shift notes from staff, APS documents, and three years of rent checks for R1. LPA interviewed Administrator, Assistant Administrator, Licensee and delivered findings. See LIC 9099C Substantiated In regard to the allegation” Staff did not give resident sufficient notice of rate increase.”, It is alleged that during R1’s stay at facility every year the rate would increase without written notification. During interview with Administrator, Assistant Administrator and Licensee all three (3) staff stated that whenever there is a rate increase family or responsible parties are always notified. Staff stated that R1’s POA was always late with the monthly payments. Licensee stated that the initial Admission Agreement was for $2600 but due to financial hardships that in 2024 a new admission agreement was made to reflect a lower amount of $1900 to help the family. LPA conducted a file review of monthly rent checks and it was revealed that in 2022 R1’s POA was paying $3100 when staff was asked to explain the discrepancy LPA was told that it was due to POA always being late the year prior, so they were making up the payments. LPA asked for documents to support this, and none could be provided. LPA also observed a written email signed by licensee that in April of 2023 R1’s monthly payment was $1940 but according to copies of checks provided in April of 2023 $3314 was paid to facility by POA. Licensee stated that R1’s condition had changed since he/she had first arrived at the facility and more services were needed. All staff indicated that R1’s POA was hard to get ahold of, and phone numbers provided were always changing. LPA could not obtain any document from facility that POA was notified of any rate increase. In regard to the allegation” Staff are billing resident for services not rendered”, It is alleged that facility was billing R1 for a private room when in fact R1 was sharing a room. During interview with Administrator, Assistant Administrator, and Licensee and three (3) stated that resident initially had a single bedroom but because of changes to R1’s condition it was in R1’s best interest to be moved to bedroom in front so staff could keep an eye on resident. Licensee stated that R1’s condition had worsened and that POA was notified over the phone of the room change. It was also revealed that the reason for any rate increase was because more services were being provided. LPA asked to see documents of the change of condition of resident and Licensee was only able to provide appraisal needs and service plan for the years 2022, 2024, and 2025. LPA asked when room were changed and there was no documents indicating date. Licensee stated that appraisal needs and service plan are done every year but didn’t know why they were not in R1’s file to indicate the initial date of change of condition. Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22 and Health and Safety Code. An exit interview was conducted, and a copy of this report was given to Caregiver. In regard to the allegation” Staff did not provide resident a complete copy of the Admission Agreement.” It is alleged that R1’s POA never received a complete copy of Admission Agreement after several attempts to the facility. During interview with Administrator, Assistant Administrator, and Licensee all three (3) stated that an admission agreement is always given to residents and family. All three staff stated that they do not recall ever receiving a request for a copy of the agreement. Administrator stated that R1’s POA was very hard to get ahold of and that the phone was always not working. LPA obtained a completed copy of two admission agreements both signed by POA. LPA attempted to contact W1 but was unsuccessful due to the phone number provided being disconnected. Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was given to caregiver.the state’s words, verbatim · CDSS document, Apr 19, 2026 · control 18-AS-20240112143536

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.655 · Plan of correction due date: May 1, 2026

§1569.657 Rate increase due to change in level of resident care; notice (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. This requirement is not being met as evidenced by: LPA observed resident #1 rate was increased for the year 2022 and R1's family was not provided a written notifiaction of a rate increase due to a change in R1's condition.the state’s words, verbatim · CDSS document, Apr 19, 2026

Plan of correction: Licensee will draft a plan as to what needs to be done prior to a rate increase and send to LPA by POC due date. Licensee can not provide a refund to R1 or POA because R1 has since passed away and POA's phone is no longer in service.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(f) · Plan of correction due date: May 1, 2026

87463 Reappraisals (f) The licensee shall immediately, or as soon as reasonably possible, communicate with the resident and, if applicable, the resident's representative, about any significant change in condition and the recommendation, if any, of the appropriate licensed medical professional, and if applicable, other specialized care provider. Documentation of such communication shall be added to the resident’s record. This requirement is not being met as evidenced by: Licensee did not have R1's initail change of condition documented. Licensee could not provide documents that POA was notified of any additional services needed. R1 was moved from a private room to a shared room because of change of condition.the state’s words, verbatim · CDSS document, Apr 19, 2026

Plan of correction: Licensee will draft a plan to insure all residents appraisel needs and services are updated and send plan to LPA by POC due date. Licensee will insure all family members and responsible partys are notified when a change of condition is observed.

Type of visit: Required - 1 Year

On 4/7/2026 Licensing Program Analyst (LPA) Mia Lankford met with Lance Abano ( Caregiver) for an unannounced Annual Inspection. LPA stated the reason for the visit. There were (3) three residents in the home. Facility Overview: The facility is a one-story home with (4) bedrooms and (2) bathrooms, including an attached garage. There are no pools or known firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. Laundry equipment was in good working condition. Sharps and Knives were securely locked and inaccessible to residents. Both the smoke detector and carbon monoxide detector were operable, and the hot water temperature was 110°F. Fire extinguisher located at dining area has proof of purchase dated January 18, 2027. Cont. Cont. Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods. Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current Administrator’s certificate expires 11/5/2026. Record Review and Resident/Staff Files: LPA reviewed files for (2) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. (3) resident files were reviewed and contained all required documentation. Health-Related Services/Incidental Medical Services: All resident medications were securely locked. LPA reviewed medications for (3) residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last fire drill conducted on 1/24/2026, which met department requirements. All facility exits were clear of obstructions. No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed and provided.the state’s words, verbatim · CDSS document, Apr 7, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced annual required visit. Upon entry, LPA was greeted by Dorothy Arnold, caregiver, and informed them of the purpose of the visit. At the time of the visit, there were (2) staff members and (6) residents present. Facility Overview: The facility is a one-story home with (4) bedrooms and (2) bathrooms, including an attached garage. There are no pools or known firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. The outdoor area was free of hazards. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked and inaccessible to residents. Both the smoke detector and carbon monoxide detector were operational, and the hot water temperature was 110°F. Fire extinguisher located at dining area has proof of purchase dated March 2025. Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods. Continued on LIC809-C.... Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate. Record Review and Resident/Staff Files: LPA reviewed files for (4) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. (6) resident files were reviewed and contained all required documentation. Health-Related Services/Incidental Medical Services: All resident medications were securely locked. LPA reviewed medications for (3) residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last fire drill conducted on 2-1-2025, which met department requirements. All facility exits were clear of obstructions. No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed and provided.the state’s words, verbatim · CDSS document, Apr 8, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kathleen Banrasavong arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction and visit purpose. Upon arrival LPA learned that six (6) clients live at this facility. There was two (2) staff members present. The Caregiver, Dorothy Arnold conducted and completed the facility tour. Client Records/Incident Reports/Clients Rights Information: LPA reviewed client records. Six (6) records were reviewed. LPA reviewed for identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, placement, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. Personnel Records/Training/ Staffing/ Administration: LPA reviewed employee records. Two (2) records were reviewed. LPA reviewed employee records for first aid certification, criminal record clearance or an exemption, health screening and TB test results, employee rights, training verification, and current administrative organization. Marlon Fredrick Uy’s Administrator’s certificate expiration date is 11/05/2024. Food Service: Food prep areas are clean and organized. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables. Emergency food and water supply is present. There is a location for sharps in the kitchen. Physical Plant and Safety of Environment/Operational Requirements: LPA toured the facility inside and outside. LPA observed the facility to be clean and in good repair. The facility is maintained at 75 degrees for the client’s comfort. Lighting is sufficient for safety. Water temperature measured 107.0 degrees F. Laundry is done in the laundry room. There is a locked closet for storing laundry soap, cleaning supplies and chemicals in the closet located in the laundry room. All outdoor and indoor passageways are free of obstruction. Emergency lighting is available. There is a telephone working at this location. LPA dialed the facility’s landline number, which rang and was operable. The LIC 610, emergency disaster plan is maintained. There are no firearms at this facility. There are no fireplaces at this facility. There are no pools at the facility. There are two (2) gates that have a self-latching lock on the northwest and northeast of the house. LPA observed emergency supplies and two (2) first aid kits. The last emergency fire drill was conducted on 04/01/2024. Infection Control: The LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies and hand washing signs. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan which met department requirements. LPA reviewed staff records and found that all staff had infection control training. Medications/Health Related Services/Incidental Medical Services: The medications are centrally stored. There is a locked cabinet allocated for medication storage. Centrally stored medication and destruction logs are maintained separately. LPA reviewed medication logs and observed if they were dispensed accurately. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. LPA observed six (6) smoke detectors and one (1) carbon monoxide detectors throughout the facility. There was one (1) fire extinguishers on site, date bought was 03/10/2024. Pursuant to the Title 22 of The California Code of Regulations Division 6, there are zero (0) deficiencies observed. An exit interview was conducted, this LIC 809 was reviewed with, and a copy of this report was provided to The Caregiver, Dorothy Arnold.the state’s words, verbatim · CDSS document, Apr 26, 2024