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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 547200844
Report Date: 09/27/2025
Date Signed: 09/27/2025 12:59:56 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/31/2025 and conducted by Evaluator Shawna Doucette
COMPLAINT CONTROL NUMBER: 24-AS-20250731084237
FACILITY NAME:MARBELLA VISALIAFACILITY NUMBER:
547200844
ADMINISTRATOR:RANCOUR, MANDYFACILITY TYPE:
740
ADDRESS:3120 W. CALDWELLTELEPHONE:
(559) 735-0828
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:72CENSUS: 40DATE:
09/27/2025
UNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Resident Care Director Brittany PolmanTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Licensee did not refund resident's preadmission fee
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced complaint visit and was granted entry by Resident Care Director Brittany Polman. LPA explained the purpose of the visit. Resident Care Director Brittany Polman contacted Administrator Mandy Rancour via telephone who gave permission for Resident Care Director Brittany Polman to assist with the visit.

Based on interviews and records review, R1 left the facility on 7/3/25 and did not receive a refund within the contract agreement. Records review of admissions agreement states residents will receive refunds within 21 business days. Facility did not issue a check to R1 until 8/22/25.

Based on interviews and records review, the preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. A deficiency is being cited on the attached 9099-D.

A copy of this report with plans of corrections and appeal rights were provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexandria Walton
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2025
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/31/2025 and conducted by Evaluator Shawna Doucette
COMPLAINT CONTROL NUMBER: 24-AS-20250731084237

FACILITY NAME:MARBELLA VISALIAFACILITY NUMBER:
547200844
ADMINISTRATOR:RANCOUR, MANDYFACILITY TYPE:
740
ADDRESS:3120 W. CALDWELLTELEPHONE:
(559) 735-0828
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:72CENSUS: 40DATE:
09/27/2025
UNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Resident Care Director Brittany PolmanTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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9
Licensee overcharged resident for services
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced complaint visit and was granted entry by Resident Care Director Brittany Polman. LPA explained the purpose of the visit. Resident Care Director Brittany Polman contacted Administrator Mandy Rancour via telephone who gave permission for Resident Care Director Brittany Polman to assist with the visit.

Based on records review, the Licensee charged the pre admissions fee and the monthly rent which is listed in R1's contract. Facility did not overcharge R1.
This agency has investigated the complaint alleging, Facility is overcharging a resident for services. Based on interviews and records review, We have found that the complaint was UNFOUNDED, which means the the allegation could not have happened, and/or is without reasonable basis, therefore we have dismissed the complaint.

A copy of this report was provided.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Alexandria Walton
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 24-AS-20250731084237
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: MARBELLA VISALIA
FACILITY NUMBER: 547200844
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/03/2025
Section Cited
CCR
87507(g)(5)(A)
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87507 Admission Agreements (g) Admission agreements shall specify the following: (5) Refund conditions (A) Facility policy concerning refunds, including the conditions under which a refund for advanced monthly fees will be returned....
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Licensee agrees to submit in writing to LPA how this regulation will be met by POC due date 10/3/25
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pursuant to Health and Safety Code section 1569.652. This requirement was not met as evidenced by: Licensee did not refund R1 timely. R1's admissions agreement states refunds will be issued within 21 business days. R1 moved out of facility on 7/3/25 and refund was not issued until 8/22/25 which poses a potential health safety and or personal rights risk to residents in care.
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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: Alexandria Walton
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3