306004637-9-23-2021-22-AS-SSAS-CM5S67-20221215123526

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004637
Report Date: 09/22/2021
Date Signed: 09/23/2021 11:20:43 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/26/2021 and conducted by Evaluator Jenifer Tirre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210226094738

FACILITY NAME:	SOLEIL SENIOR LIVING		FACILITY NUMBER:	306004637
ADMINISTRATOR:	LISA GAITAN		FACILITY TYPE:	740
ADDRESS:	23741 SINGAPORE STREET		TELEPHONE:	(949) 716-7614
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	6	CENSUS: 6	DATE:	09/22/2021
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Administrator, Scott Branson		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility did not provide resident's family with proper refund.

INVESTIGATION FINDINGS:

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On this day Licensing Program Analyst (LPA) Jenifer Tirre met with Administrator Scott Branson in person to deliver findings on a complaint investigation discussing the above allegations. During the investigation LPA Tirre interviewed staff as well as toured facility. LPA gathered pertinent documentation for investigation including records and receipts.
The agency has investigated the complaint alleging “Facility did not provide resident’s family with proper refund”. Investigation revealed that on February 1, 2021 Hospice Equipment was picked up from facility. Investigation revealed that residents Amended admission agreement stated that in the event of a resident passing away, Soliel Senior Living will provide a prorated refund from the day all the residents belongings and medical equipment have been picked up from facility. Investigation revealed that facility did issue resident’s family with a refund however due to conflicting reports and information of timeline of events we have found that although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur therefore the allegation is UNSUBSTANTIATED.
A exit interview was conducted with Administrator and a copy of this report was provided to the facility.
***THIS IS AN AMENDED REPORT***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021

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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