315920217-7-16-2026-59-AS-LMUZ-DW6QZH-20260720123647

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 315920217
Report Date: 07/16/2026
Date Signed: 07/16/2026 10:32:43 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/01/2026 and conducted by Evaluator Melissa Parks

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20260701113507

FACILITY NAME:	TWELVE BRIDGES RESIDENCE LLC		FACILITY NUMBER:	315920217
ADMINISTRATOR:	TULLGREN, DIANA		FACILITY TYPE:	740
ADDRESS:	409 CONFEDERATION CT		TELEPHONE:	(916) 396-4189
CITY:	LINCOLN	STATE: CA	ZIP CODE:	95648
CAPACITY:	6	CENSUS: 4	DATE:	07/16/2026
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Rowena Poynter		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Staff member handled resident(s) in a rough manner while in care.
Licensee retaliated against resident in care.
Staff do not ensure that resident's needs are met while in care.
Staff did not ensure that resident(s) were provided a comfortable temperature while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Melissa Parks arrived on Thursday July 16, 2026, unannounced to conclude a complaint investigation which the Department received on 7/1/2026. LPA met with staff and explained the purpose of the visit.

LPA interviewed staff and R1’s hospice nurse regarding the allegations. LPA reviewed R1’s file including physicians report, medication list, preplacement appraisal, needs and services plan, and admission agreement. LPA learned the following:

R1’s responsible party has a camera in the room. They are able to hear when R1 yells. According to interviews, R1 will yell when staff are repositioning or providing care. Per staff, they are frequently in the room providing care. R1 is diagnosed with vascular dementia. According to R1’s physicians report, they experience hallucinations and disorientation.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026

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 59-AS-20260701113507

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: TWELVE BRIDGES RESIDENCE LLC	FACILITY NUMBER: 315920217
	VISIT DATE: 07/16/2026

NARRATIVE

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Per the administrator, there was a discussion of eviction with R1’s responsible party. R1's responsible party and the administrator acknowledged that no written eviction notice was provided. R1 remains that the facility.

LPA interviewed staff who stated that R1 is fed the same meals which are provided to the other residents. The facility follows a weekly menu. On 7/8/2026, LPA observed R1’s lunch plate which consisted of chopped meat, potatoes and bread. According to staff, R1 is repositioned frequently. R1 does not currently have any skin issues. R1 was admitted to the facility with a stage 2 pressure sore but this has resolved. The facility has 24 hour awake staff to provide care as needed.

LPA reviewed R1’s medication list. R1 is prescribed two medications for a skin rash: one pill and a topical ointment. Per the medication list, both medications had a start date of February 2026. R1 moved into the facility in May 2026. R1 was diagnosed with a rash at their previous residence and began treatment before moving into this facility. Per R1’s hospice nurse, the rash is not due to lack of care or the facility temperature. Additionally, the facility maintains the air conditioning between 72 and 74 degrees. LPA observed the temperature to be 73 degrees on 7/8/2026 and 7/16/2026. R1 has a fan in their room provided by their responsible party which can be used as needed.

Based on the evidence provided, the preponderance of evidence standards was not met, therefore, the above allegations are found to be UNFOUNDED. An unfounded allegation means that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview conducted. A copy of this report was left at the facility.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026

LIC9099 (FAS) - (06/04)

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