435200051-4-18-2022-26-AS-KHOS-CDWP7B-20220428110339

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435200051
Report Date: 04/18/2022
Date Signed: 04/18/2022 04:59:58 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/23/2022 and conducted by Evaluator Chihhsien Chang

COMPLAINT CONTROL NUMBER: 26-AS-20220223135916

FACILITY NAME:	PARKVIEW RCH #2		FACILITY NUMBER:	435200051
ADMINISTRATOR:	HELEN NG		FACILITY TYPE:	740
ADDRESS:	919 ROSETTE COURT		TELEPHONE:	(408) 736-5618
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94086
CAPACITY:	6	CENSUS: 5	DATE:	04/18/2022
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Elma Pacursa		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility refuse to provide a refund.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Steve Chang conducted an unannounced complaint visit to deliver the investigation finding and met with administrator (ADM) Elma Pacursa.

On 02/23/2022, the Department received a complaint of the above allegation. On 02/28/2022, LPA interviewed licensee (LNS) Helen Ng and obtained R1's Admission Agreement, facility policy and the letter of explanation on the charge for R1.

Continued, see LIC 9099-C, pages 1 of 2.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR NAME: Chihhsien Chang	TELEPHONE: (408) 904-9843
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2022

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 26-AS-20220223135916

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: PARKVIEW RCH #2	FACILITY NUMBER: 435200051
	VISIT DATE: 04/18/2022

NARRATIVE

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Facility refuse to provide a refund:

On 02/28/2022, licensee (LNS) Helen Ng stated that a refund was offered on 2/20/22; however applicant's responsible party refused to pick up the refund check citing a discrepancy in the refund amount. Based on the review of documents, admission agreement(AD) was signed on 2/6/22 with a move in date of 2/15/22. Applicant's furniture were moved in on 2/6/22; however applicant decided not to move in on 2/15/22 and removed the furniture on 2/21/22. The review of the agreement policy noted processing fee of $200 charged if AD signed but did not move in all deposit made to secure the room prior to admission are non-refundable. Applicant put down a deposit of $1000 and processing fee of $200. Per Title 22 Section 87507(g)(5)(E)(2)(a) A refund of at least 80% of the pre-admission fee in excess of $500 shall be provided if the applicant does not enter the facility after a pre-admission appraisal is conducted or the resident leaves the facility for any reason during the first month of residency. Thus the department would recommend the 80% of $1000 deposit be refunded. Facility can charge for the time when the furniture was in the facility as the room was held for the applicant.

The Department has investigated the above allegation. Based on interviews conducted and records reviewed, the Department found that the above allegation is UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur.

Exit interview conducted with ADM. A copy of this report was provided for signature. A copy of this report was emailed to ADM.

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (408) 324-2112
LICENSING EVALUATOR NAME: Chihhsien Chang	TELEPHONE: (408) 904-9843
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2022

LIC9099 (FAS) - (06/04)

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