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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803822
Report Date: 12/11/2025
Date Signed: 12/11/2025 12:21:58 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
09/02/2025 and conducted by Evaluator Jill Nakagawa
COMPLAINT CONTROL NUMBER: 21-AS-20250902213521
FACILITY NAME:MAGNOLIA COURTFACILITY NUMBER:
486803822
ADMINISTRATOR:MOSES, CANDICEFACILITY TYPE:
740
ADDRESS:1111 ULATIS DRTELEPHONE:
(707) 447-7100
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY:146CENSUS: 84DATE:
12/11/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kristine Soriano, AdministratorTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Staff chemically restrained residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nakagawa arrived unannounced to continue an investigation regarding the above allegation and to deliver findings. LPA discussed with Administrator Kristine Soriano.

The complaint alleges that Staff chemically restrained residents. The reporting party states that “according to multiple staff members who overheard the exchange, the Executive Director instructed med techs to administer PRN medications to all residents in Memory Care for the purpose of keeping them calm…”.
Continued on 9099-C.....
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
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 2
Control Number 21-AS-20250902213521
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: MAGNOLIA COURT
FACILITY NUMBER: 486803822
VISIT DATE: 12/11/2025
NARRATIVE
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Continued from 9099....

LPA conducted interviews with medication technicians, LVNs and Care Coordinator who all stated that medications are administered only as prescribed and all PRN dosages are documented. LPA reviewed the medication administration record (MAR) of (8) of (30) memory care residents for the month of August 2025 who receive PRN medications and found no irregularities. LPA’s inspection of the medications and prescriptions found (5) of (8) residents only receive a PRN pain reliever such as Tylenol, (2) of (8) receive another PRN medication for pain, and only (1) resident receives a PRN medication for anxiety. PRN medications must be authorized and given as per prescription and charted. LPA attempted to reach the reporting party for further information but reporting party did not respond. Based on record review and interview with medication technicians, care staff and licensed Vocational Nurses on staff dispensing medications the allegation that Staff chemically restrained residents is unsubstantiated. Although the allegation may have occurred there is not a preponderance of evidence therefore the allegation is UNSUBSTANTIATED.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2