Complaint Investigation Report

216803606-6-9-2026-21-AS-VBEI-DV7SDQ-20260619134732

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

06/01/2026 and conducted by Evaluator Caitlynn Felias

COMPLAINT CONTROL NUMBER: 21-AS-20260601221435

Lack of staff supervision resulting in resident sustaining a fracture while in care

Staff did not address resident's fall risk

At approximately 8:55AM, Licensing Program Analyst arrived unannounced at the facility met with Administrator, Justine Herrera. The purpose of the visit was to close a complaint investigation regarding the above allegations. Complaint investigation was opened in error under the wrong facility number, as the resident indicated in the complaint report does not reside at this facility address.

Based on record review and observations made, these allegations are Unfounded. A finding of Unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.