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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019201373
Report Date: 07/10/2026
Date Signed: 07/10/2026 04:39:55 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/16/2026 and conducted by Evaluator Alicia Delmundo
COMPLAINT CONTROL NUMBER: 15-AS-20260416134918
FACILITY NAME:BELLARA SENIOR LIVINGFACILITY NUMBER:
019201373
ADMINISTRATOR:COLLETTE VALENTINEFACILITY TYPE:
740
ADDRESS:22400 2ND STREETTELEPHONE:
(510) 244-0949
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY:175CENSUS: 167DATE:
07/10/2026
UNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Karren Melad/Resident Care Director
and Jeff Sumabat/Executive Director		TIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Facility failed to issue appropriate refund.
INVESTIGATION FINDINGS:
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On this day, June 10, 2026, at 10:55 am, Licensing Program Analyst (LPA) Delmundo arrived unannounced to deliver the findings for the above allegation and close the complaint. LPA met with Resident Care Director (RSD) Karren Melad and informed the reason for visit. LPA later met with Executive Director Jeff Sumabat.

It was alleged that the facility failed to issue appropriate refund to resident, R1.

During the course of investigation, LPA reviewed R1’s record and obtained copies of the following documents: Admission Agreement; LIC601 Identification and Emergency Contact Information; Authorization Agreement for Direct Payment (ACH); payment records; refund check of $6,368.57 dated March 6, 2026. LPA conducted interviews.

....continued on 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2026
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 2
Control Number 15-AS-20260416134918
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: BELLARA SENIOR LIVING
FACILITY NUMBER: 019201373
VISIT DATE: 07/10/2026
NARRATIVE
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The Executive Director (ED) stated that Bellara has concessions that if a resident move-in 12/31/25, the month rent will only be $99.00 on the first month and the community fee is only $2,500.00 which is only 50% of the regular $5,000.00 community fee, and R1's moved-in on the record is 12/31/25. The concession of $99.00 on the first month is for 1/01/26 to 1/31/26.

S1 confirmed Bellara’s concession. S1 stated that R1 had put a check mark on ACH Authorization of 1 month current and 1 month future rent and that there was an error in Bellara’s billing that R1 was charge full for community fee and full month rent for January 2026. S1 further stated a refund check has been generated dated March 6, 2026 but since R1 should be getting more than the amount on the check, she called and informed R1 on 3/06/26. S1 also stated she was looking at the correct amount that should be refunded and that the refund check with the correct amount should be ready in a week. She never heard from R1 after 3/06/26.

On 5/01/26, ED informed LPA that the refund check was hand delivered to R1 on 5/01/26. RP informed LPA of the receipt of the check.

Based on information gathered, the allegation in unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred.



No deficiency cited.

The Executive Director has to leave and stated Karren Melad will sign and receive this report.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2