342700157-4-10-2025-59-AS-LMUZ-DFQSZ4-20250414141828

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700157
Report Date: 04/10/2025
Date Signed: 04/10/2025 10:55:41 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
03/26/2025 and conducted by Evaluator Talwinder Bains

COMPLAINT CONTROL NUMBER: 59-AS-20250326121727

FACILITY NAME:	CHALET, THE		FACILITY NUMBER:	342700157
ADMINISTRATOR:	SUSIE DIZON		FACILITY TYPE:	740
ADDRESS:	6487 MAIN STREET		TELEPHONE:	(925) 787-2740
CITY:	ORANGEVALE	STATE: CA	ZIP CODE:	95662
CAPACITY:	41	CENSUS: 22	DATE:	04/10/2025
		UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Co-administrator, Suzanne Dizon		TIME COMPLETED:	11:05 AM

ALLEGATION(S):

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Staff did not provide responsible party with a refund.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 04/10/25 to deliver complaint findings for the above allegation. LPA met with Co-administrator, Suzanne Dizon and explained the purpose of the visit.

The department conducted record review, interview with administrator and with witness to investigate this allegation. Record review indicated that resident, R1s responsible party had deposited pre-admission fee of $2250.00 for R1 to move in to the facility around 01/25/25 but R1 was hospitalized on 01/20/25 where passed away on 02/02/25 . R1s family notified the facility regarding R1s death on 02/03/25 and facility refunded $1125.00 to R1s family. During the complaint investigation, administrator’s interview reflected that they attempted to contact R1s family regarding the refund of remainder amount, $1125.00 after 02/03/25 but was not successful. Department was made aware on the complaint opening visit date, 03/27/25 that facility had issued the full refund of $2250.00 as indicated by facility and R1s family and this issue has been resolved.

Based on this information, this allegation was found to be UNFOUNDED. We have found the complaint was UNFOUNDED, meaning that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit interview conducted and copy of the report was provided at the end.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025

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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