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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 097002991
Report Date: 09/10/2026
Date Signed: 09/10/2026 10:38:48 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/01/2026 and conducted by Evaluator Lavinia Muscan
COMPLAINT CONTROL NUMBER: 59-AS-20260901121621
FACILITY NAME:NEW WEST HAVEN IIFACILITY NUMBER:
097002991
ADMINISTRATOR:TANIA LANGLANDFACILITY TYPE:
740
ADDRESS:2551 CAMEO DRIVETELEPHONE:
(530) 677-2979
CITY:CAMERON PARKSTATE: CAZIP CODE:
95682
CAPACITY:67CENSUS: 35DATE:
09/10/2026
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Med Tech Karina HernandezTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Facility staff did not issue a refund
INVESTIGATION FINDINGS:
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On 9/10/2026, Licensing Program Analysts (LPAs) Lavinia Muscan and Talwinder Bains arrived at the facility unannounced to open and deliver complaint findings into the allegation listed above and met with Med Tech Karina Hernandez. During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation. The results of the investigation are as follows:
Based on regulation requirements (87507(g)(5)(A)(1) Admission Agreements), facility should have paid refund to R1's responsible party within 15 days after R1's death. R1’s responsible party received a refund of $1925 on September 4, 2026, 5 months after R1’s death which was on April 18, 2026. Based on Title 22 regulations, licensee did not issue a refund to R1's responsible party within 15 days therefore, department finds that the allegation Substantiated. A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The deficiencies are cited on 9099-D, per Title 22 Regulations, Division 6.

Exit interview with administrator. Appeals rights provided. Copy of the report provided to facility.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 59-AS-20260901121621
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: NEW WEST HAVEN II
FACILITY NUMBER: 097002991
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/24/2026
Section Cited
CCR
87507(g)(5)(A)(1)
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Admission Agreements(g) Admission agreements shall specify the following:
(5) Refund conditions(A) Facility policy concerning refunds, ...conditions under which a refund for ... fees will be returned in the event of a resident’s death, pursuant to Health and Safety Code section 1569.652… must be made to the individual...for the payment of the resident’s fees,... identified in admission agreement. 1569.652(c) A refund … within 15 days after the personal property is removed. This requirement was not as evidence by-
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Licensee/Administrator agrees to submit a statement of understanding of this regulation and send proof of refund payment to CCL by the POC date 9/24/26.
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From record review, it was found that facility did not pay the refund to R1s family/responsible party within 15 days of R1s death as required per regulation which poses a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2026
LIC9099 (FAS) - (06/04)
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