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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496804113
Report Date: 08/19/2025
Date Signed: 08/19/2025 04:56:30 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 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
07/10/2025 and conducted by Evaluator Dina Alviso
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20250710164923
FACILITY NAME:FOUNTAINGROVE LODGEFACILITY NUMBER:
496804113
ADMINISTRATOR:LEONE, MEGAN E.FACILITY TYPE:
741
ADDRESS:4210 THOMAS LAKE HARRIS DRIVETELEPHONE:
(707) 576-1101
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY:173CENSUS: DATE:
08/19/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Megan Leone-AdministratorTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Staff did not issue proper refund to resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alviso conducted a complaint inspection, on 8/19/25 at approximately 9:45am, and met with Administrator Megan Leone.

Reporting party alleges "staff did not issue proper refund to resident". LPA reviewed resident R1's records, obtained copies of documents, interviewed staff, and reviewed information obtained from other parties. The investigation revealed that per the contract agreement, page six, 7.2.2., the "entrance fee refund" for an apartment/bungalow, resident would receive the repayment amount within fourteen (14) calendar days after the former apartment/bungalow is reoccupied by a new resident who has executed a residence & services agreement, and paid the applicable entrance fee for the apartment/bungalow, or one hundred twenty (1200 months after the agreement was terminated, whichever is earlier. R1's former apartment was reoccupied by a new resident, resident signed a residence & services agreement, and applicable entrance fee was paid on 6/1/2025. Administrator provided documentation that resident R2 occupied the apartment, signed an admission agreement, and paid applicable entrance fee on 6/1/2025.
Continued on LIC9099C..
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2025
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 3
Control Number 21-AS-20250710164923
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: FOUNTAINGROVE LODGE
FACILITY NUMBER: 496804113
VISIT DATE: 08/19/2025
NARRATIVE
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Resident R1 received from Fountaingrove Lodge licensee a refund check on 6/24/25, which was short by $258.71. Administrator offered to have accounting of Fountaingrove Lodge send another check for the owed amount of $258.71. R1 refused this offer and requested that Fountaingrove Lodge provide a new check with the full owed "entrance fee refund". R1 returned the check with the incorrect amount of their refund to the Administrator. The second check requested from Fountaingrove Lodge licensee was received by the resident R1 on 8/6/2025.

Investigation revealed, the first refund check to return owed funds to R1, from former unit's occupancy on 6/1/25, was received outside of the required 14 days from this date, per contract.

Per review of records, conducted interviews with staff and other related parties, information obtained, the allegation of "staff did not issue proper refund to resident" is substantiated.

The following deficiency will be cited, HSC1788.4.(a)(e) Refunds A lump-sum payment after termination of a repayable contract, as defined in paragraph (3) of subdivision (r) of Section 1771, shall not be considered to be a refund and may not be characterized or advertised as a refund. The full lump sum owed, including any interest accrued, shall be paid to the resident within 14 calendar days after resale of the unit, see LIC9099D.

The preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is being cited.

Failure to correct deficiencies by due dates, may result in additional deficiency citations and/or civil penalties being assessed.

Appeal Rights Given.
Exit interview conducted with the Administrator Megan Leone.





SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 21-AS-20250710164923
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: FOUNTAINGROVE LODGE
FACILITY NUMBER: 496804113
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/19/2025
Section Cited
HSC
1788.4(a)(e)
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HSC1788.4. (a)( e)Refunds A lump-sum payment after termination of a repayable contract, as defined in paragraph (3) of subdivision (r) of Section 1771, shall not be considered to be a refund and may not be characterized or advertised as a refund. The full lump sum owed, including any interest accrued, shall be paid to the resident within 14 calendar days after resale of the unit,
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Licensee to ensure that all resident refunds/lump sums owed are refunded to the resident and/or resident's estate per facility's contract agreement. Submit plan of future compliance with this H&S code for future terminations/cancellations of contract agreements. POC due 9/5/2025.
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This requirement was not met as evidenced by: Investigation revealed, the first refund check to return owed funds to R1, from former unit's occupancy on 6/1/25, was received outside of the required 14 days from this date, per contract. This is a risk to resident's rights.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2025
LIC9099 (FAS) - (06/04)
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