Complaint Investigation Report

486803090-6-5-2025-21-AS-CMAZ-DHLRZ5-20250613132719

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SANTA ROSA RO , 1450 NEOTOMAS AVENUE, STE. 100

This is an official report of an unannounced visit/investigation of a complaint received in our office on

06/03/2025 and conducted by Evaluator Anthony Loera

COMPLAINT CONTROL NUMBER: 21-AS-20250603093211

Staff did not provide a refund to authorized representative

Licensing Program Analyst (LPA) Loera conducted a complaint investigation regarding the above allegation. LPA reviewed resident and facility records and interviewed Administrator. Resident (R1) had passed away on 01/22/2025. According to the admission agreement, licensee agrees to refund any fees within 15 days paid in advance covering the time after the residents items have been removed. LPA was informed by administrator that R1's personal belongings were removed from the room on 01/24/2025, therefore the refund would start from 01/25/2025 through 01/31/2025. A total amount due for a refund is calculated for 7 days. Facility has paid a refund amount of approximately 5 days. A balance is still due to be paid to responsible party/authorized representative for the remaining days.

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), is being cited on the attached LIC 9099D. Appeal Rights were given to the Administrator