complaint·August 8, 2025

Allegations: “Facility did not issue a proper refund” and “Paperwork was not completed in a timely manner” It was reported that the Licensee of Appleton Homes did not issue a refund to Resident #1’s (R1) representative and did not complete the required documents prior to admission. R1 was admitted to the facility on 02/14/2025 and was immediately removed by R1’s representative on 02/15/2025. The facility’s resident Admission Agreement stated “Facility charges $500 non-refundable move-in fee. This fee is to be used to review the client’s needs assessments, to process forms. There is no security deposit” and “Prior to admission, RESIDENT or RESIDENT’S responsible person shall furnish to FACILITY a current physician’s medical report, tuberculosis clearance and participate in an assessment evaluation (pre-admission appraisal).” R1’s representative reported that on 02/14/2025 during the admission, the Licensee provided blank forms and requested the representative to sign the documents. Additionally, the resident’s representative was not provided copies of the documentation signed and the Licensee did not review any forms with the representative. Witness #1 (W1) confirmed that blank documents were provided for signatures, documents were not reviewed or explained by the Licensee, and no communication from the facility was reported prior to 02/14/2025. The Admission Agreement, Telecommunications Device Notification, Consent for Emergency Medical Treatment, Personal Rights, and Release of Client/Resident Medical Information were completed and signed on 02/14/2025. R1’s Preplacement Appraisal, Appraisal/Needs and Services Plan, and Theft and Loss Policy were signed on 02/14/2025 and blank. R1’s Identification and Emergency Information was signed, but not dated, was also incomplete. Report Continued on LIC 9099-C The facility’s Refund Policy stated: “As required by law, if the resident is evicted because of … (5) Upon movement or family decided to send love one at home or any preferred Facility … NO REFUND, and should remove personal belongings immediately.” R1’s representative reported they requested a refund, and the Licensee stated they did not owe the representative any money. Interview with the Licensee revealed the resident’s representative requested a refund and per the admission agreement, they needed to give at least a 30-day notice. The Licensee stated “they showed up the next day and moved (R1) out.” The facility’s Admission Agreement also stated under the Conditions For Termination of Agreement: “This agreement may be terminated by RESIDENT upon thirty (30) days’ written notice to FACILITY.” R1’s representative provided a written and signed notice on 02/15/2025 at 3:05PM, during the removal of R1. Based on interview and record review, the Licensee did not abide by the policies written in the admission agreement. R1 was not assessed prior to admission, forms were not processed, and a Physician’s Report without TB result was obtained prior to admission. Additionally, documents provided to R1’s representative during the admission on 02/14/2025 for signatures were not reviewed. The preponderance of evidence standard has been met, therefore the allegations are deemed SUBSTANTIATED at this time. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies are cited (Refer to LIC9099-D). Exit interview conducted. A copy of the appeal rights and today’s report was reviewed and provided. Allegation: " Resident was not provided ample storage space for personal items" It was reported that Resident #1 (R1) was not provided ample storage space for their personal items. Title 22 CA Code of Regulation section 87307(a)(3)(B) stated “Bedroom furniture, which shall include, for each resident, a chair, night stand, a lamp, or lights sufficient for reading, and a chest of drawers.” Based on LPA Huynh’s observation during the visit, each resident was provided with the listed items with an additional closet space in each bedroom. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed UNSUBSTANTIATED at this time. No deficiency cited related to the allegation. Exit interview conducted. A copy of today’s report was reviewed and provided.