286804069-4-1-2025-21-AS-KMOA-DFLTCR-20250410143709

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 286804069
Report Date: 04/01/2025
Date Signed: 04/01/2025 12:05:51 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
12/11/2024 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20241211154024

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: 72	DATE:	04/01/2025
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Dorla Licausi		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff did not call emergency services for residents in care
Staff did not prevent residents from smoking inside the facility
Staff did not prevent residents from sleeping on the facility floor
Staff did not prevent residents from entering other resident rooms
Staff did not prevent resident from interfering with resident's care needs

INVESTIGATION FINDINGS:

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At approximately 9:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct an investigation into the above allegations. LPA met with Executive Director Dorla Licausi, reviewed records and interviewed staff. Based on records reviewed, LPA was not able to find evidence so support the allegations listed above. Records reviewed showed the facility contacted emergency services when residents are in need and basic first aid is provided when emergency services are not required. Based on interviews conducted and records reviewed, the facility has a strict no smoking indoor policy. Residents, however, are able to make decisions and not follow the policy. When smoking indoors is observed, staff remind residents of the risk and request they use the outdoor smoking areas. Based on records reviewed, residents have been found sleeping in areas other than their rooms. Records show when a resident is found sleeping in public areas, they are checked on and assisted back to their rooms. Based on records reviewed, residents are sometimes found in other resident rooms. Residents are checked on and assisted to their own rooms. Staff document the interaction and when needed, care plans are updated to increase monitoring of residents. LPA was not able to find evidence to show residents are interfering with other residents care needs. 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.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE:	DATE: 04/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2025

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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