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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 126803830
Report Date: 04/15/2026
Date Signed: 04/15/2026 11:06:06 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/27/2026 and conducted by Evaluator Christopher Arnhold
COMPLAINT CONTROL NUMBER: 21-AS-20260227110953
FACILITY NAME:SEQUOIA SPRINGS SENIOR LIVING COMMUNITYFACILITY NUMBER:
126803830
ADMINISTRATOR:ALMA PERALTAFACILITY TYPE:
740
ADDRESS:2401 REDWOOD WAYTELEPHONE:
(707) 726-0111
CITY:FORTUNASTATE: CAZIP CODE:
95540
CAPACITY:92CENSUS: DATE:
04/15/2026
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Julissa AguirreTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Medication not given as ordered
Personal rights
INVESTIGATION FINDINGS:
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At approximately 8:15AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to deliver the investigative findings from an investigation into the above allegations. LPA met with Compliance and Training Coordinator Julissa Aguirre. During the course of this investigation, LPA reviewed records and conducted interviews. Based on records reviewed and interviews conducted, LPA was not able to find evidence to support the allegations. LPA reviewed the medication records and observed R1 had two orders for a PRN medication that stated the medication was to be given by mouth three (3) times daily as needed. There were no restrictions placed on timing between doses. One prescription was for a 0.5 MG amount and the other for 1 MG. Documents show a 0.5 MG tablet was given on 2/18/2026, at 6:11AM and again at 2:15PM. The 1 MG medication was given at 4:01PM and again at 5:15PM. These amounts and timing are within the prescribed time frames. Based on interviews conducted, the allegation of Personal Rights was in regards to staff speaking in a loud, rude manner towards R1 and physically restraining them. LPA was not able to gather additional statements regarding these behaviors. Records reviewed showed documentation of bruising being found on R1's wrists and arms and a skin tear with a bandage that was not present the day before. LPA did not find documentation of the cause of the injuries. Continued on LIC9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
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 21-AS-20260227110953
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: SEQUOIA SPRINGS SENIOR LIVING COMMUNITY
FACILITY NUMBER: 126803830
VISIT DATE: 04/15/2026
NARRATIVE
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LPA reviewed R1's care plan and notes regarding staff observations. LPA observed R1 routinely walked around and was at times aggressive towards staff. R1 was also noted to be a high fall risk and there were several documented falls. LPA advised facility management to conduct refresher training on documenting injuries post fall and the have staff document the healing process of those injuries.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
LIC9099 (FAS) - (06/04)
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