Complaint Investigation Report

216804066-1-14-2026-21-AS-CMAZ-DPFTSZ-20251217135957

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

11/25/2025 and conducted by Evaluator Anthony Loera

COMPLAINT CONTROL NUMBER: 21-AS-20251125121454

Licensee does not ensure the facility has enough staffing

On 12/30/2025, Licensing Program Analyst (LPA) Loera conducted an unannounced visit for the purpose of delivering complaint findings regarding the above allegation. LPA arrived and met with Business Manager, Karina Vasquez. During the investigation, LPA conducted interviews, reviewed documents and made observations.

During the course of the investigation, LPA was provided with documentation for complaint 21-AS-20251119091655 that relates to the above allegation. A review of residents (R1) care notes state on October 20th, 2025, and November 1st, 2025, facility was “short staff”. On October 16th and November 22nd review of R1s care notes state that there was no med tech on shift, resulting in residents unable to be administered their medications if needed.

Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Division 6, Chapter1 is being cited on the attached LIC 9099D. Appeal rights given. *civil penalty being assessed in the amount of $250.00 for repeat violation in a 12 month period*

*report amended to relfect correct civil penalty amount*