486802066-10-19-2026-21-AS-VBEI-DZ42L2-20261021172849

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486802066
Report Date: 10/19/2026
Date Signed: 10/19/2026 09:41:27 AM

Unsubstantiated

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
06/24/2026 and conducted by Evaluator Caitlynn Felias

COMPLAINT CONTROL NUMBER: 21-AS-20260624100728

FACILITY NAME:	CLARIN'S RESIDENTIAL CARE HOME		FACILITY NUMBER:	486802066
ADMINISTRATOR:	CLARIN, JULIANA		FACILITY TYPE:	740
ADDRESS:	3024 CLEAR COAST COURT		TELEPHONE:	(707) 557-6837
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94591
CAPACITY:	6	CENSUS: 2	DATE:	10/19/2026
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Staff Member, Primero Benustina, and Licensee, Juliana Clarin (Melegrito)		TIME COMPLETED:	09:50 AM

ALLEGATION(S):

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Staff did not provide medical attention to resident in a timely manner

INVESTIGATION FINDINGS:

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At approximately 9:20AM, Licensing Program Analyst (LPA) Felias arrived unannounced to deliver findings for a complaint investigation regarding the above allegation and met with Staff Member, Primero Benustina, and Licensee, Juliana Clarin (Melegrito).

During the investigation, the Department reviewed records, conducted interviews, and made observations. There is an allegation of “Staff did not provide medical attention to resident in a timely manner.” Complaint alleged that on 06/15/2026, Resident 1 (R1) arrived to their Dialysis appointment with bandages on their arm. When the bandages were removed, it was observed that R1 had numerous blisters and boils on their arm and that the access site looked infected. Per report, the Licensee was contacted who stated that they knew about R1’s condition and that R1’s hospice agency looked at the arm and did not believe it was a concern.

Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2026

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 21-AS-20260624100728

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: CLARIN'S RESIDENTIAL CARE HOME	FACILITY NUMBER: 486802066
	VISIT DATE: 10/19/2026

NARRATIVE

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Continued from LIC9099

Interview with Licensee stated that on Sunday, 06/14/2026, R1 had a fall which resulted in a skin tear on their arm. Licensee contacted R1’s hospice agency to assess R1 and R1 received first aid. Per Licensee, R1 did not have any blisters on Sunday, 06/14/2026. Licensee further stated that on Monday, 06/15/2026, blisters were observed on R1 by the Blize Hospice Caregiver before R1 went to Dialysis. Per Licensee, R1 did not look to be in pain on the morning of 06/15/2026. Licensee also stated that they asked R1’s Hospice Nurse what R1’s blisters could be and was told it could be fluid retention caused by R1’s medication.

Interview with R1’s Responsible Party revealed that they saw R1 on Friday, 06/12/2026, Saturday, 06/13/2026, and Sunday, 06/14/2026. Per Responsible Party, they went to see R1 on 06/14/2026 after being informed of their fall and skin tear and did not observe any blisters on that day. Interview with Responsible Party further stated that they spoke with R1’s Hospice Nurse who stated that they did not observe any blisters on R1 when they assessed them on Sunday, 06/14/2026, and applied first aid. Per Responsible Party, the cause of R1’s blisters is unknown.

Multiple attempts to contact R1’s hospice agency to corroborate information were unsuccessful. Review of R1’s hospice progress notes did not indicate what happened the morning of 06/15/2026.

Based on record review, interviews conducted, and observations made, this allegation is Unsubstantiated. A finding that a complaint allegation is Unsubstantiated means that 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.

Exit interview conducted. Copy of report discussed and provided to Licensee. Signature on form confirms receipt of documents.

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2026

LIC9099 (FAS) - (06/04)

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