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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496802016
Report Date: 04/15/2022
Date Signed: 04/15/2022 01:15:51 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/15/2022 and conducted by Evaluator Victoria Willis
COMPLAINT CONTROL NUMBER: 21-AS-20220215100907
FACILITY NAME:WINDSOR HOUSE IIFACILITY NUMBER:
496802016
ADMINISTRATOR:JOHN SCHOONOVERFACILITY TYPE:
740
ADDRESS:113 LEAFY GLADE PLACETELEPHONE:
(707) 838-9602
CITY:WINDSORSTATE: CAZIP CODE:
95492
CAPACITY:6CENSUS: 5DATE:
04/15/2022
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Administrator, John SchoonoverTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Facility has not issued a refund
INVESTIGATION FINDINGS:
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Licensing Program Analyst Willis arrived unannounced to deliver findings regarding the above complaint allegation and met with Administrator, John Schoonover.

Facility has not issued a refund – Complaint alleges that facility has not refunded a resident or their responsible party the deposit and one months rent despite the resident not moving into the facility. Information gathered during the investigation showed that resident’s responsible party gave a check dated August 12, 2021 which was approximately two and a half weeks prior to the planned move in date to the facility of September 1, 2021. The Deposit Receipt which was signed by the resident’s responsible party, identified this check as a deposit to hold the room until the first of the month adding that it is non-refundable. Based on language from the signed agreement and interview with Administrator, the deposit is applied to the first month’s rent if resident moves into the facility before the deposit hold date.

Continued on LIC9099
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Willis
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2022
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 21-AS-20220215100907
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: WINDSOR HOUSE II
FACILITY NUMBER: 496802016
VISIT DATE: 04/15/2022
NARRATIVE
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Continued from LIC9099C

On 8/30/2021, the resident was admitted to the hospital. On 8/31/2021, the resident’s personal items were put into their room at the facility in anticipation of the resident moving in. On that day, the resident’s responsible party gave the facility the first month’s rent check in the amount specified on the signed Admission Agreement. Document review showed that the check was for the full amount and did not have the “deposit” amount deducted. Per interview with Administrator, that was an oversight and they intended to credit that amount on the following month. Due to concerns that resident may have needed a higher level of care, the resident did not end up moving into the facility. The responsible party removed resident’s personal belongings out on 10/4/21 which was over one month after bringing their personal belongings into the facility. Per document review, the responsible party also signed an agreement indicating that they would give a 60-day notice if they were terminating the agreement. LPA was unable to find documentation that a 60-day notice was given to the facility. The deposit was applied to rent which should have been due for the month of October 2022 as per the signed agreement. Although the resident did not physically stay at the facility during the time their belongings occupied the agreed designated space, the facility was unable to admit another resident in order to generate income for this space.

This agency has investigated the complaint alleging that facility has not issued a refund. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Willis
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2