435202959-3-12-2026-26-AS-RMAO-DTFK7D-20260424073858

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202959
Report Date: 03/12/2026
Date Signed: 03/12/2026 04:15:44 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 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
01/29/2026 and conducted by Evaluator Simranjit Rai

COMPLAINT CONTROL NUMBER: 26-AS-20260129130847

FACILITY NAME:	BONITA SPRINGS SENIOR LIVING		FACILITY NUMBER:	435202959
ADMINISTRATOR:	CERA, DULCE		FACILITY TYPE:	740
ADDRESS:	1818 SCOTT BLVD		TELEPHONE:	(669) 242-7150
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95050
CAPACITY:	32	CENSUS: 17	DATE:	03/12/2026
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Human Resources (HR) Aisha Syed		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Licensee is financially abusing resident as refund was not provided after death of resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai spoke with the Administrator (ADM) Dulce Cera and met with Case Manager (CM) Melissa Diatte and Human Resources (HR) Aisha Syed stated the purpose of today’s visit. ADM provided verbal authorization for Aisha Syed to sign today's report on ADM's behalf.

On 01/29/2026, the Department received a complaint with the above allegation. On 02/05/2026, the Department conducted an initial investigation at the facility.

It was alleged the resident’s responsible party was not provided with a refund after resident passed away. The Department was not provided with resident’s name or other information, but it was stated the resident only stayed at the facility for less than a month.

Continuation on LIC 9099-C, Page 1 of 3.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026

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 3

Control Number 26-AS-20260129130847

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: BONITA SPRINGS SENIOR LIVING	FACILITY NUMBER: 435202959
	VISIT DATE: 03/12/2026

NARRATIVE

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Page 2 of 3.

On 02/05/2026, LPA Rai interviewed staff (S1) and Administrator (ADM) Dulce Cera. Both staff reviewed the facility records to review the list of residents that passed away at the facility in 2025. Both staff stated resident (R1) was a resident who stayed at the facility for less than a month in 2025. Both staff stated R1 moved to the facility on 10/02/2025 and R1 was admitted to hospice services at the facility the same day. Both staff stated R1 passed away at the facility on 10/08/2025 under Hospice services and in terms of the addendum to Admission Agreement, the facility is not issuing a refund, but in this case, they made an exception. Both staff stated R1’s responsible party was provided with a refund check, and it was cashed out within the week.

Based on review of R1’s Admission Agreement effective admission date 10/02/2025, page 5 out of 16, “in the event of your death, a pro-rated refund of prepaid rates will be made from the date that all of your personal belongings are removed from your room. Refunds will be processed within fifteen (15) days. R1’s admission agreement is signed by R1’s responsible party (RP). Based on review of R1’s Addendum to Admission Agreement, “No Refund for Hospice Admissions: In the Event that a resident is admitted to the Facility wile already under the care of hospice agency, the Facility shall not issue any refunds of paid fees in the event of the resident’s discharge or death.” and it was signed by R1’s responsible party on 10/01/2025.

Based on review of R1’s refund check dated 10/20/2025, the check was issued to R1’s responsible party and memo on the check stated, “Refund of room and board charges for R1”. Based on review of facility’s bank records, R1’s refund check dated 10/20/2025 was cashed out on 10/23/2025.

During today’s visit, LPA Rai interviewed 4 staff (S1-S3), including Administrator (ADM) Dulce Cera. LPA Rai wanted to clarify the amount of money issued on the refund check. ADM stated the amount decided for R1’s refund check was 30% of the monthly rate and preadmission fee. ADM stated R1’s responsible party was agreeable to the amount of the refund check as the check was cashed, and no issues were brought up to ADM.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 26-AS-20260129130847

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: BONITA SPRINGS SENIOR LIVING	FACILITY NUMBER: 435202959
	VISIT DATE: 03/12/2026

NARRATIVE

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Page 3 of 3.

The Department has completed the investigation of the above allegation. Based on interviews conducted and record reviews, the Department has found that the above allegation were UNFOUNDED, meaning that the allegation were false, could not have happened and/or are without a reasonable basis.

No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Human Resources (HR) Aisha Syed and a copy of the report was provided.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 3