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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415600105
Report Date: 07/13/2026
Date Signed: 07/13/2026 11:30:31 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/26/2025 and conducted by Evaluator Jaime Vado
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20251126082125
FACILITY NAME:CHATEAU SABELLEFACILITY NUMBER:
415600105
ADMINISTRATOR:NANCY CASTLEFACILITY TYPE:
740
ADDRESS:2921 ISABELLE STREETTELEPHONE:
(650) 341-2296
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY:6CENSUS: 6DATE:
07/13/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator - Nancy CastleTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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-Staff did not seek timely medical attention for resident's pressure injury

INVESTIGATION FINDINGS:
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On 07/13/2026, Licensing Program Analyst (LPA) Jaime Vado conducted an unannonced complaint investigation visit to deliver findings regarding the allegations received. LPA met with Nancy Castle and explained the purpose of today's visit.

During the investigation by the Department, interviews were conducted, resident facility records, resident medical records were reviewed, and these records were received and maintained. It was found that caregivers S1 and S2 noticed the pressure injury on the resident and applied Medihoney and a dry sterile dressing to it the area. The administrator Nancy Castle stated that this was not reported to managment for assessment. Additionally, co-administrator Armand Atienza spoke to S1 and S2 about the pressure injury and it not being reported, and both stated that they thought someone else had already reported it.

Continued on next page...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Jaime Vado
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2026
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 4
Control Number 14-AS-20251126082125
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CHATEAU SABELLE
FACILITY NUMBER: 415600105
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/13/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/14/2026
Section Cited
CCR
87465(a)
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87465(a) Incidental Medical and Dental Care - (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care. This regulation has not been met as evidenced by:
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Licensee shall develop a plan of action in writing describing how the facility will ensure that appropriate care, observation of residents for injuries, and seeking timely medical attention for any findings or injuries that may develop.
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Based on medical records reviewed, and interviews conducted, the licensee failed to perform care and supervision to the resident to address the care need of a resident who developed an stage 3 pressure injury while in care which is considered a serious bodily injury.
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Immediate civil pealty is assessed in the amount of $500 due to the serious bodily injury in developing the stage 3 pressure injury.
Type A
07/14/2026
Section Cited
CCR
87405(d)1
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87405(d)1 Administrator - Qualifications and Duties: (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply.
(1) Knowledge of the requirements for providing care and supervision appropriate to the residents. This regulation has not been met as evidenced by:
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Licensee shall develop a plan of action in writing describing how the administrator will demonstrate knowledge of this regulation.
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Based on medical records reviewed, and interviews conducted, the licensee failed to perform care and supervision to a resident by not addressing the care needs of a resident who developed a stage 3 pressure injury while in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: April Cowan
LICENSING EVALUATOR NAME: Jaime Vado
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/26/2025 and conducted by Evaluator Jaime Vado
COMPLAINT CONTROL NUMBER: 14-AS-20251126082125

FACILITY NAME:CHATEAU SABELLEFACILITY NUMBER:
415600105
ADMINISTRATOR:NANCY CASTLEFACILITY TYPE:
740
ADDRESS:2921 ISABELLE STREETTELEPHONE:
(650) 341-2296
CITY:SAN MATEOSTATE:CAZIP CODE:
94403
CAPACITY:6CENSUS: 5DATE:
07/13/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator - Nancy CastleTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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-Resident sustained a pressure injury due to neglect and lack of care
INVESTIGATION FINDINGS:
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On 07/13/2026, Licensing Program Analyst (LPA) Jaime Vado conducted an unannonced complaint investigation visit to deliver findings regarding the allegations received. LPA met with Nancy Castle and explained the purpose of today's visit.

During the investigation by the Department, interviews were conducted, resident facility records, resident medical records were reviewed, and these records were received and maintained. R1was bedbound and diagnosds with a disease, which caused physical decline, muscle loss, and limited mobility. Staff stated R1 had preventative measures for pressure injuries that included repositioning, nutrition (protein intake), an alternating pressure pump mattress, compression sleeves, and support pillows. Staff stated R1 was also resistant during care and would sometimes move the pillows used for positioning, and staff would have to reposition the pillows. Interviews showed that there was an effort in care in place but due to resident behaviors, some of these preventative care measures were negated. This allegation is unsubstantiated.

Based on these observations, the above allegations are UNSUBSTANTIATED.
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, therefore the above allegations are unsubstantiated at this time. Report is reveiwed with Nancy and a copy is provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Jaime Vado
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 14-AS-20251126082125
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: CHATEAU SABELLE
FACILITY NUMBER: 415600105
VISIT DATE: 07/13/2026
NARRATIVE
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Page 2 - LIC9099


The injury began as a redness but progressed to a stage 3 pressure injury and the resident did not receive timely medical attention. S3 reported that S2 reported to him/her on an unknown date that they noticed that R1 had redness in the area of the injury and advised them to apply cream and report to the administrator. S3 explained that caregivers are responsible for reporting concerns about the residents assigned to their care to the administrators.

Based on LPA interviews, Department investigation, items received, and medical records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, are being cited on the attached LIC9099D.

The deficiencies for the above substantiated allegations is cited in accordance with California Code of Regulations, Title 22, Division 6 and is noted on attached LIC9099D. An immediate Civil Penalty of $500 is assessed for a violation that resulted in a resident sustaining a serious bodily injury. Additional civil penalties may be assessed.

Report is reviewed with Nancy Castle and a copy is provided with appeal rights. A copy of the civil penalty will be provided
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Jaime Vado
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4