286804069-3-19-2026-21-AS-BMOS-DT4PBF-20260413111017

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 286804069
Report Date: 03/19/2026
Date Signed: 03/19/2026 01:09:18 PM

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
12/19/2025 and conducted by Evaluator Julie Florio

COMPLAINT CONTROL NUMBER: 21-AS-20251219144634

FACILITY NAME:	INN ON VILLA LANE, THE		FACILITY NUMBER:	286804069
ADMINISTRATOR:	DORLA LICAUSI		FACILITY TYPE:	740
ADDRESS:	3255 VILLA LANE		TELEPHONE:	(707) 252-3333
CITY:	NAPA	STATE: CA	ZIP CODE:	94558
CAPACITY:	86	CENSUS: 80	DATE:	03/19/2026
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Dorla Licausi, Administrator		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Staff does not administer resident’s medication in a timely manner.
Staff does not keep an accurate medication log.

INVESTIGATION FINDINGS:

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On 03/19/2026, at approximately 10:15 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct an additional interview and deliver complaint investigation findings regarding LIC802 - Complaint Report #21-AS-20251219144634, which was received by Community Care Licensing (CCL) on 12/19/2025. Reporting Party (RP) alleges that staff does not administer resident’s medication in a timely manner and staff does not keep an accurate medication log. LPA met with Dorla Licausi, Administrator.

On 12/19/2025, LPA conducted an interview, obtained douments, and requested statements from Staff 1 (S1) and Staff 2 (S2) and additional documents which were received via email on 12/21/2025. Based on interviews conducted, written statements obtained from S1 and S2 and recieved via email on 12/21/2025, review of the facility's controlled substance log, and the medication administratrion record (MAR) for Resident 1 (R1), it was revealed that S1 gave R1 their medication on time.

Continued on LIC9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2026

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-20251219144634

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: INN ON VILLA LANE, THE	FACILITY NUMBER: 286804069
	VISIT DATE: 03/19/2026

NARRATIVE

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Continued from LIC9099...

Additionally, based on review of R1's centrally stored medication record (CSMR), MAR, and the facility's controlled substance log for the month on 12/2025, LPA did not find any evidence to show that the facility staff are not keeping an accurate medication log.

Based on interviews conducted, observations made, and records reviewed, the allegations that staff does not administer resident’s medication in a timely manner and staff does not keep an accurate medication log are UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

No deficiencies cited.

Exit interview conducted with Administrator, whose signature on form confirms receipt of document(s).

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2026

LIC9099 (FAS) - (06/04)

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