Complaint Investigation Report

126803830-8-19-2025-21-AS-VBEI-DL8SXV-20250905141633

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SANTA ROSA RO , 1450 NEOTOMAS AVENUE, STE. 100

This is an official report of an unannounced visit/investigation of a complaint received in our office on

08/01/2025 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20250801164515

At approximately 10:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an investigation into the above allegation. LPA met with Executive Director Alma Peralta, interviewed staff and reviewed records. Based on records reviewed, Resident, R1, went to the hospital on 07/25/2025 for a change in condition. R1 was admitted to the hospital. Based on records reviewed, R1 returned to baseline on 07/29/2025 and was to be discharged but facility refused to accept them back. R1 returned to the facility on 08/08/2025 receiving hospice care.

Based on the Departments investigation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

This report was reviewed with Alma Peralta and Appeal rights were given.