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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803298
Report Date: 06/03/2026
Date Signed: 06/05/2026 09:04:22 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
03/19/2026 and conducted by Evaluator Ali Deniz
COMPLAINT CONTROL NUMBER: 21-AS-20260319164025
FACILITY NAME:KELLYS FAMILY CARE #2FACILITY NUMBER:
486803298
ADMINISTRATOR:JACKSON-BRANCHCOMB, REGYNAFACILITY TYPE:
735
ADDRESS:2504 SUNRISE DRIVETELEPHONE:
(707) 421-2950
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:5CENSUS: 3DATE:
06/03/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Regyna Jackson-Branchcomb, AdministratorTIME COMPLETED:
10:55 AM
ALLEGATION(S):
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Facility does not have the required amount of perishable foods
INVESTIGATION FINDINGS:
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At approximately 09:30 AM, Licensing Program Analyst (LPA) Ali Deniz arrived unannounced to deliver findings for a complaint investigation regarding the above allegation and met with Administrator, Regyna Jackson-Branchcomb.
During the course of the investigation, the Department conducted interviews, reviewed documents, and made observations. The following allegation was investigated: “Facility does not have the required amount of perishable foods.”
It was alleged that the facility did not maintain the required amount of perishable food items for residents in care. During the investigation, LPA conducted interviews with the Administrator and toured the facility. The Administrator stated groceries are typically ordered through a food delivery application on a weekly basis or as needed.
During the inspection, LPA observed food available at the facility, including frozen and nonperishable food items. Although concerns were reported regarding the quantity of fresh food available, LPA did not observe evidence indicating that the facility lacked sufficient food for residents in care at the time of the visit.
Continued in LIC9099-C page...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2026
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 5
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
03/19/2026 and conducted by Evaluator Ali Deniz
COMPLAINT CONTROL NUMBER: 21-AS-20260319164025

FACILITY NAME:KELLYS FAMILY CARE #2FACILITY NUMBER:
486803298
ADMINISTRATOR:JACKSON-BRANCHCOMB, REGYNAFACILITY TYPE:
735
ADDRESS:2504 SUNRISE DRIVETELEPHONE:
(707) 421-2950
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:5CENSUS: 5DATE:
06/03/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Regyna Jackson-Branchcomb, AdministratorTIME COMPLETED:
10:55 AM
ALLEGATION(S):
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2
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9
Personal Rights
Facility is not safe, sanitary and in good repair
INVESTIGATION FINDINGS:
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At approximately 09:30AM, Licensing Program Analyst (LPA) Deniz arrived unannounced to deliver findings for a Complaint Investigation regarding the above allegations and met with Administrator, Regyna Jackson-Branchcomb.

During the course of the investigation, the Department requested and reviewed documents, conducted interviews, and made observations. The following allegations were investigated: “Personal Rights” and “Facility is not safe, sanitary and in good repair.”

“Personal Rights” - Complaint alleged that clients’ personal rights were impacted due to the condition of the facility and living environment. During the inspection, LPA observed a portable commode and a staff member's bed located in the clients' common living area. LPA also observed that the staff member was utilizing a significant portion of the living room and common area space during recovery from a recent surgery.
Continued on LIC9099-C page...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 21-AS-20260319164025
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: KELLYS FAMILY CARE #2
FACILITY NUMBER: 486803298
VISIT DATE: 06/03/2026
NARRATIVE
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Continued from LIC9099 page...

The Administrator stated that the staff member was the House Manager and resided at the facility.
The presence of staff personal belongings and recovery equipment within the common living area reduced the clients' unrestricted access to and use of the shared space. Photographs were taken during the inspection.

Based on observations and interviews conducted during the investigation, the allegation is Substantiated. A finding that the complaint allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

“Facility is not safe, sanitary and in good repair” - Complaint alleged that the facility was not maintained in a safe, sanitary, and good repair condition. During the investigation, LPA observed a strong odor smell in the staff room where one cat was present. There was a cat litter box on the floor underneath a bookshelf in the dining room area, kitchen drawers containing crumbs and debris, and curtain rods in two client bedrooms that were buckling and not functioning properly. The Administrator acknowledged the concerns observed during the inspection and agreed to clean the kitchen cabinets and surrounding surfaces. LPA also observed that repairs to holes behind client bedroom doors had already been completed. There were four stray cats at the backyard area.

Based on observations made and interviews conducted during the investigation, the allegation is Substantiated. A finding that the complaint allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Exit interview conducted. Copy of report, LIC9099D, Plan of Corrections, Appeal Rights, and Corrections Letter discussed and provided to Licensee. Signature on form confirms receipt of documents.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 21-AS-20260319164025
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: KELLYS FAMILY CARE #2
FACILITY NUMBER: 486803298
VISIT DATE: 06/03/2026
NARRATIVE
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Continued from LIC9099 page...

During the inspection, the Administrator placed an additional order for fresh food items.
Based on interviews conducted, records reviewed, and observations made during the investigation, there was insufficient evidence to support the allegation that the facility did not maintain the required amount of perishable foods. Therefore, the allegation is Unsubstantiated.

A finding that the 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: Ali Deniz
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 21-AS-20260319164025
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: KELLYS FAMILY CARE #2
FACILITY NUMBER: 486803298
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/03/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/15/2026
Section Cited
CCR
80087(a)
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80087(a) Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors
This requirement is not met as evidenced by:
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Licensee agrees to submit proof of repaired curtains and cleaned kitchen drawers to Community Care Licensing by plan of correction due date 06/15/2026
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LPA observed a strong odor smell in the staff room, kitchen drawers containing crumbs and curtain rods in were buckling. Based on observation, the licensee did not comply with the section cited above which poses a potential health and safety risk to persons in care.
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Type B
06/15/2026
Section Cited
CCR
85087(a)(3)
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85087(a)(3) Building and Grounds
(a) In addition to Section 80087, bedrooms must meet, at a minimum, the following ...: (3) No room commonly used for other purposes shall be used as a bedroom for any person.
This requirement is not met as evidenced by:
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Administrator agreed to read and get an understanding of the regulation and cleare common area for client's use and submit proof of correction Community Care Licensing by plan of correction due date 06/15/2026
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LPA observed a portable commode and a staff member's bed located in the clients' common living area. Based on observation, the licensee did not comply with the section cited above which poses a potential health and safety risk to persons 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: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5