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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200922
Report Date: 04/22/2025
Date Signed: 04/22/2025 03:23:21 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/17/2025 and conducted by Evaluator Alicia Delmundo
COMPLAINT CONTROL NUMBER: 15-AS-20250117103258
FACILITY NAME:MORNINGSTAR SENIOR LIVING OF HAYWARDFACILITY NUMBER:
019200922
ADMINISTRATOR:HENRY, CAYIAFACILITY TYPE:
740
ADDRESS:1200 RUSSELL WAYTELEPHONE:
(510) 727-1700
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY:170CENSUS: 99DATE:
04/22/2025
UNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Nanensila 'Nancy' Randhawa/Executive Director
and Rosana Frias/Associate Executive Director		TIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Facility failed to issue appropriate refund.
INVESTIGATION FINDINGS:
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On this day, 04/22/2025, at 1:05 p.m., Licensing Program Analyst (LPA) Delmundo arrived unannounced to continue the investigation of the above allegation and close the complaint. LPA met with Associate Executive Director (AED) Rosana Frias and Executive Director (ED) Nanensila 'Nancy' Randhawa, and informed the reason for visit.

It was alleged that resident (R1) was moved-out on 05/04/2024 but the facility was able to withdraw the full rent payment for 05/2024. R1's responible person (FM) has paid the facility $780.00 prorated amount for May 1-4, 2024; however, when FM was issued the refund, FM only received $7280.00, which means the prorated amount of $780.00 was deducted despite FM paying the facility the prorated amount.

....continued on 9099C


Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2025
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 15-AS-20250117103258
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: MORNINGSTAR SENIOR LIVING OF HAYWARD
FACILITY NUMBER: 019200922
VISIT DATE: 04/22/2025
NARRATIVE
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During the course of investigation, LPA obtained copies of R1's Admission Agreement and document showing R1's move-out date which confirmed R1 moved-out on 05/04/2024. LPA also obtained copies of Authorization Agreement for Direct Payment (ACH) and payment records for R1.

LPA interviewed FM on 01/21/2025 who stated he cancelled the automatic payment for 05/2024, somehow the payment still went through but the facility got the money before he cancelled the auto payment. FM further stated that he received a refund check of $7280.00 but when he deposited it, it bounced. On 01/29/2025, LPA received an e-mail from FM stating that it was a mistake on his end with the bank.

LPA interviewed AED on 01/24/2025 who stated she is aware of issues regarding the refund and that the $7280.00 check refund was cancelled by MorningStar. AED called and spoke with FM on 02/06/2025 regarding the issue. The telephone call was followed by an email to FM confirming the communication between her and FM and that no balance is owed by either FM and facility.

Based on information gathered, the allegation is closed as unfounded. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

No deficiency cited.

Exit interview conducted and copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2