Complaint Investigation Report

496803811-8-28-2025-21-AS-BMOS-DLBV3M-20250908160458

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 1450 NEOTOMAS AVENUE, STE. 100

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

08/26/2025 and conducted by Evaluator Marisol Cuadra

COMPLAINT CONTROL NUMBER: 21-AS-20250826155234

-Staff did not issue a refund to resident's authorized representative.

Licensing Program Analyst (LPA) Cuadra conducted a complaint investigation regarding the above allegation. Licensee was out of town unable to come to the facility but was available via phone and gave authorization to staff to sign the report. LPA reviewed resident and facility records and interviewed Licensee. Per Reporting party, Resident (R1) passed away on April 9, 2025, and they removed R1’s belongings as of April 14, 2025. According to the admission agreement, the licensee agrees to refund any fees within 15 days paid in advance covering the time after the residents’ items have been removed. Based on interviews conducted by LPA with the Licensee it was confirmed that R1's personal belongings were removed from the room, and they agreed with R1’s responsible party to round down the refund to $3000, but according to the Licensee there have been some pinches. However, Licensee stated that the facility will be issuing the refund to R1’s responsible party by not later than September 15, 2025, and it was communicated to R1’s responsible party on 8/27/25 via phone. 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 given.