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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486801245
Report Date: 05/23/2025
Date Signed: 05/23/2025 01:57:16 PM

Substantiated


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
05/07/2025 and conducted by Evaluator Star Stevenson
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20250507100732
FACILITY NAME:BRISTOL HOMEFACILITY NUMBER:
486801245
ADMINISTRATOR:PUNZALAN, ELPIDIOFACILITY TYPE:
735
ADDRESS:1930 BRISTOL LANETELEPHONE:
(707) 373-6385
CITY:FAIRFIELDSTATE: ZIP CODE:
94533
CAPACITY:4CENSUS: DATE:
05/23/2025
UNANNOUNCEDTIME BEGAN:
11:54 AM
MET WITH:TIME COMPLETED:
02:05 PM
ALLEGATION(S):
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Personal Rights
INVESTIGATION FINDINGS:
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LIcensing Program Analysts (LPAs) Cuadra and Stevenson arrived unannounced to conduct a complaint investigation and deliver finding of a compliant investigation and met with Administrator Patricia Bucal and assistantant administrator Virgina Punzalan.

The department received an allegation of Personal Rights violation. Per reporting party, on 05/07/2025, client (C1) stated that live-in staff (S1 & S2) returned from a recent vacation (exact date unknown), since their return, both staff members exhibted verbally aggressive behavior toward C1, describing their tone as loud, and at times, they yelled at them (C1) (unknown words), it appears that ice coffee was requested from staff, but they refused. C1 felt dislike based on their manner of commuincation toward them. However, C1 seems to like the home, a home she has lived at for 9 years and expressed her wish to continue residing at the facility. LPAs conducted 10-day visit on 05/08/2025, made observations, obtained and requested pertinent documentation, conducted interviews with staff and clients in care.

Continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2025
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 3
Control Number 21-AS-20250507100732
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: BRISTOL HOME
FACILITY NUMBER: 486801245
VISIT DATE: 05/23/2025
NARRATIVE
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Continued from LIC9099

Based on interviews with staff (S1, S2, & S3), LPAs learned that S1 was previously given corrective actions through counseling and verbal warning due to verbal abuse towards clients at the facility. On 05/13/2025, LPAs received written communication dated 05/09/2025 a termination letter issued by the Licensee to S1 adn determined that there was supporting evidence that the verbal abuse violation had occurred and S1 was requested to take their personal belongings and leave the premises of the facility by not later than 05/10/2025 or sooner. On 05/23/2025, LPAs conducted collateral visit to conduct interviews with clients and obtained verbal statements that corroborated the above allegation. The preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulation, (Title 22, Division 6, Chapter 8), is cited on the attached LIC 9099D. Appeal Rights Given.

The Department will be reviewing the information obtained to determine if further actions are needed.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 21-AS-20250507100732
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: BRISTOL HOME
FACILITY NUMBER: 486801245
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/24/2025
Section Cited
CCR
80072(a)(1)
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80072(a)(1) Personal Rights
(a)...each client shall have personal rights which include, but are not limted to, the following: (1) To be accored dignity in his/her personal relationships with staff and other persons. This requirement has not been met as evidence by:
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Licensee to review regulation 80072(a)(1) and have all staff trained on verbal abuse. Evidence of dates and subjects of staff training to be submitted to Community Care Licensing (CCL) by Plan of Correction (POC) due date of 05/24/2025. Staff trainings to include date, subject, staff names and signatures.
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Based on interviews and records review, the facility termintated staff (S1) due to internal investgation conducted by the facility revealed verbal abuse towards C1 which poses an immediated risk to the health and safety of clients 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.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3