502701713-6-1-2026-27-AS-LKIG-DWLMDT-20260803093140

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502701713
Report Date: 06/01/2026
Date Signed: 06/01/2026 04:43:27 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
05/26/2026 and conducted by Evaluator Noel Wolf Petersen

COMPLAINT CONTROL NUMBER: 27-AS-20260526112535

FACILITY NAME:	PLEASANT VALLEY MEMORY CARE		FACILITY NUMBER:	502701713
ADMINISTRATOR:	WHITELEY, JENNIFER		FACILITY TYPE:	740
ADDRESS:	1248 NELSON AVE		TELEPHONE:	(925) 594-1122
CITY:	MODESTO	STATE: CA	ZIP CODE:	95350
CAPACITY:	90	CENSUS: 51	DATE:	06/01/2026
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Stephanie		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Staff did not issue a refund to a resident in care.

INVESTIGATION FINDINGS:

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The Licensing Program Analyst, LPA arrived to the facility to the facility to conduct a complaint investigation, into the above allgations. The LPA met with the administrator Stephanie Issakahini to explain the purpose of the visit.

In interview it was learned a resident(r1) was relocated from the facility, January 9th 2026, dying under the care of another facility January 12th 2026. The estate representatives of r1 sought a claim on the facility of prepaid monthly rate prorated to 21 days(1168.14$) as a refund for services not rendered to the client(client being incapacitated by death).

LPA recived a copy of the resident(r1) admission agreement, and it and its attached addenda does not state refund conditons. The policy should be contained in the admission agreement as outlined in health and safey code 1569.884(h), "The facility’s policy concerning refunds, including the conditions under which a refund for advanced monthly fees will be returned...".

Continued on C page.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2026

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 27-AS-20260526112535

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: PLEASANT VALLEY MEMORY CARE	FACILITY NUMBER: 502701713
	VISIT DATE: 06/01/2026

NARRATIVE

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Because of the facilities admission agreement not having a refund policy, the agreement being discussed is then without a document supporting it. LPA reviewed communication from the facility to representatives of the estate outlining an argument against paying a refund, but on the basis of not providing 30 days notice to quit.

LPA's review of the admission agreement does state, "Provide 30 days notice of intent to move from the home unless the resident's physical condition prevents this from being done", creating a unintended interpretation of the document where a incapacitated resident could undermine the facilitiys reasoning to not pay a refund for services not performed in the month they moved out.

Per interview with administrator, a refund is in process of being issued, for an amount agreed to by the estate. LPA is asking for the check to be sent certified, and the party representing the resident to be notified of the incoming refund, the administrator should send the LPA confirmation of the receipt of the check. Noel.wolfpetersen@dss.ca.gov

LPA agrees that settling the dispute, even without a defined document with terms of the refund, is probably the best course of action, rather than continue the disagreement in civil court with the current basis of not providing 30 days notice to quit. LPA notes the facilitys new refund policy will be provided with an updated admission agreement, to the LPA 6/7/2026,

As the ownership structure of the License has recently changed and the obligations being paid appear to be handshake based, a Technical Violation was issued with a substantiated finding rather than a citation, a copy of the report was read and given to the administrator. A copy of the appeal rights was provided. exit interview conducted.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2026

LIC9099 (FAS) - (06/04)

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