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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415201950
Report Date: 12/16/2024
Date Signed: 12/16/2024 10:29:39 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/10/2024 and conducted by Evaluator Murial Han
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20241210143454
FACILITY NAME:ADVENT RESIDENTIAL HOMEFACILITY NUMBER:
415201950
ADMINISTRATOR:HELEN MALIG-ONFACILITY TYPE:
740
ADDRESS:617 FIFTH AVETELEPHONE:
(650) 216-0073
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94063
CAPACITY:15CENSUS: 7DATE:
12/16/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator, Helen MaligonTIME COMPLETED:
10:40 AM
ALLEGATION(S):
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Facility is not providing a refund upon resident’s death.
INVESTIGATION FINDINGS:
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On December 16, 2024, Licensing Program Analyst (LPA) Murial Han conducted an unannounced 10-day complaint visit. LPA met with the administrator, Helen Maligon and explained the purpose of today's visit.

Regarding to the allegation of- facility is not providing a refund upon resident's death, the reporting party stated that resident #1 (R1) deceased on 11/7/2024 and the monthly payment has not been refunded. Subsequently on 12/10/2024, the reporting party contacted the Department and reported that the facility has notified them that a refund check has been mailed.

As part of the investigation, LPA interviewed the administrator who stated that the refund check was not issued in a timely fashion due to miscommunication, however, on 12/10/2024, a refund was issued and she has informed R1's responsible party.

Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: April CowanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Murial HanTELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 14-AS-20241210143454
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: ADVENT RESIDENTIAL HOME
FACILITY NUMBER: 415201950
VISIT DATE: 12/16/2024
NARRATIVE
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During today's visit, the facility called R1's responsible party who confirmed that the refund has been received and provided a copy of the check.

After the investigation, this allegation is deemed unfounded.

The agency has investigated the allegation and we have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

This report is reviewed and discussed with the administrator. A copy is provided.
SUPERVISOR'S NAME: April CowanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Murial HanTELEPHONE: (619) 209-9761
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2