216801999-8-21-2026-21-AS-VBEI-DXDV8E-20260828161237

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 216801999
Report Date: 08/21/2026
Date Signed: 08/21/2026 10:39:50 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
04/07/2026 and conducted by Evaluator Caitlynn Felias

COMPLAINT CONTROL NUMBER: 21-AS-20260407102405

FACILITY NAME:	SAINT MICHAEL'S EXTENDED CARE		FACILITY NUMBER:	216801999
ADMINISTRATOR:	ZINGKHAI, RUFUS		FACILITY TYPE:	740
ADDRESS:	416 4TH STREET		TELEPHONE:	(415) 453-4600
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94901
CAPACITY:	44	CENSUS: 39	DATE:	08/21/2026
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Staff Member, Nataly Solis, and Administrator, Rufus Zingkhai		TIME COMPLETED:	10:50 AM

ALLEGATION(S):

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Due to lack of supervision, resident was pushed and harassed by another resident

INVESTIGATION FINDINGS:

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At approximately 9:00AM, Licensing Program Analyst (LPA) Felias arrived unannounced to deliver findings for a complaint investigation regarding the above allegation, and met with Staff Member, Nataly Solis. Administrator, Rufus Zingkhai, arrived during visit at approximately 9:15AM.

During the course of the investigation, the Department reviewed documents, conducted interviews, and made observations. The following allegation was investigated, "Due to lack of supervision, resident was pushed and harassed by another resident." Complaint alleged that Resident 1 (R1) was being pushed and harrassed by Resident 2 (R2). Per complaint, R2 throws R1's personal belongings onto the floor, yells and screams at them, opens the door when they are in the bathroom, and threatens them. Report also stated that another resident at the facility has heard R2 screaming at night. Additional information from the Complainant revealed that R1 and R2 were roommates, and that R1 had been becoming increasingly

Continued on LIC9099

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 21-AS-20260407102405

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: SAINT MICHAEL'S EXTENDED CARE	FACILITY NUMBER: 216801999
	VISIT DATE: 08/21/2026

NARRATIVE

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Continued from LIC9099

paranoid and delusional as a result of refusing their medications. Complainant further stated that when they spoke to facility staff members, staff had stated that they had not been on-site when R1 was allegedly pushed by R2. Department was unable to obtain information on who the other resident was that heard R2 screaming at night.

Review of R1's care plan dated 02/13/2026 and R2's care plan dated 05/16/2025, showed that both residents did not require one-on-one supervision.

Interview conducted with Administrator revealed that C1's mental health team notified them of the situation between R1 and R2 on 04/07/2026. Per Administrator, they spoke with both R1 and R2 and both residents denied the allegations, stating that they have not pushed or touched each other inappropriately. Interview further revealed that per facility protocol, facility separated R1 and R2 for their safety and moved R1 to a room located on the facility's second floor on 04/08/2026. During visit conducted on 04/17/2026, R1 was observed to be residing on the second floor of the facility. Additional documentation in R1's file further showed that R1 had entered a new roommate agreement with Resident 3 (R3) on 04/08/2026.

During visit conducted on 08/21/2026, the Department was informed that R1 had been discharged from the facility on 05/03/2026 by their mental health team.

Based on record review, interviews conducted, and observations made, this allegation is Unsubstantiated. A finding that the complaint allegation is Unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

No Deficiencies Cited during visit.

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

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2026

LIC9099 (FAS) - (06/04)

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