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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486800368
Report Date: 08/20/2026
Date Signed: 08/20/2026 02:45:54 PM

Unfounded


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
08/14/2026 and conducted by Evaluator Star Stevenson
COMPLAINT CONTROL NUMBER: 21-AS-20260814154905
FACILITY NAME:PARADISE VALLEY ESTATESFACILITY NUMBER:
486800368
ADMINISTRATOR:STACK, SHANNONFACILITY TYPE:
741
ADDRESS:2600 ESTATES DRIVETELEPHONE:
(707) 432-1100
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:743CENSUS: DATE:
08/20/2026
UNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Phyllicia Xiong-Assisted LivingTIME COMPLETED:
02:55 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 08/20/2026 Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to conducte a Personal Rights Complaint investigation recieved by Community Care Licensing (CCL) on 08/14/2026.

LPA met with Administrator Shannon Stack and Assited Living Director Phyllicia Xiong who has Designation of Facility Responsibilty (RP)

LPA made observations, obtained documents and conducted interviews.

The above complaint was determined to be UNFOUNDED.

A finding of unfounded means, the allegation was false, could not have happened and/or is without a reasonable basis.

Report was reviewed with Responsible Party, whose signature denotes receipt.





Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026
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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