Complaint Investigation Report

547200844-9-27-2025-24-AS-SMOA-DLYMEN-20250929093259

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

07/31/2025 and conducted by Evaluator Shawna Doucette

COMPLAINT CONTROL NUMBER: 24-AS-20250731084237

Licensee did not refund resident's preadmission fee

Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced complaint visit and was granted entry by Resident Care Director Brittany Polman. LPA explained the purpose of the visit. Resident Care Director Brittany Polman contacted Administrator Mandy Rancour via telephone who gave permission for Resident Care Director Brittany Polman to assist with the visit.

Based on interviews and records review, R1 left the facility on 7/3/25 and did not receive a refund within the contract agreement. Records review of admissions agreement states residents will receive refunds within 21 business days. Facility did not issue a check to R1 until 8/22/25.

Based on interviews and records review, the preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. A deficiency is being cited on the attached 9099-D.

A copy of this report with plans of corrections and appeal rights were provided.