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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803822
Report Date: 06/02/2026
Date Signed: 06/02/2026 05:51:08 PM

Substantiated


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
03/03/2026 and conducted by Evaluator Jill Nakagawa
COMPLAINT CONTROL NUMBER: 21-AS-20260303114041
FACILITY NAME:MAGNOLIA COURTFACILITY NUMBER:
486803822
ADMINISTRATOR:SORIANO, KRISTINEFACILITY TYPE:
740
ADDRESS:1111 ULATIS DRTELEPHONE:
(707) 447-7100
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY:146CENSUS: 97DATE:
06/02/2026
UNANNOUNCEDTIME BEGAN:
02:42 PM
MET WITH:Kristine Hiquiana, AdministratorTIME COMPLETED:
05:50 PM
ALLEGATION(S):
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Staff not administering medications in a timely manner.
INVESTIGATION FINDINGS:
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On 06/02/2026, Licensing Program Analyst (LPA)Nakagawa and Licensing Program Manager (LPM) Mota arrived unannounced to continue a complaint investigation regarding the above allegations and met with Administrator Kristine Hiquiana to discuss findings.

The complaint states that Staff are not administering resident's medication in a timely manner. The reporting party stated that resident R1 did not receive required medications and treatments as required per physician's orders.

Per LPA's and LPM's review of Medication Administration Record (MAR) R1
had a missed dose on 2/18/2026.

(Continued on 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2026
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
Control Number 21-AS-20260303114041
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: 06/02/2026
NARRATIVE
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(Continued from 9099)

Based on the MAR the allegation that staff did not administer resident’s medication in a timely manner is is Substantiated. Deficiency cited. (See 9099-D).

Deficiencies cited from the California Code of Regulations, Title 22 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
03/03/2026 and conducted by Evaluator Jill Nakagawa
COMPLAINT CONTROL NUMBER: 21-AS-20260303114041

FACILITY NAME:MAGNOLIA COURTFACILITY NUMBER:
486803822
ADMINISTRATOR:SORIANO, KRISTINEFACILITY TYPE:
740
ADDRESS:1111 ULATIS DRTELEPHONE:
(707) 447-7100
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY:146CENSUS: 76DATE:
06/02/2026
UNANNOUNCEDTIME BEGAN:
02:42 PM
MET WITH:Kristine Hiquiana, AdministratorTIME COMPLETED:
05:50 PM
ALLEGATION(S):
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Staff not following residents care plan.
Staff left resident in soiled diaper for a period of time.
Unqualified staff administering residents medication.
INVESTIGATION FINDINGS:
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On 06/02/2026, Licensing Program Analyst (LPA)Nakagawa and Licensing Program Manager (LPM) Mota arrived unannounced to continue a complaint investigation regarding the above allegations and met with Administrator Kristine Hiquiana to discuss findings.

The complaint alleges Staff not following residents care plan. Staff left resident in soiled diaper for a period of time. R1 was being treated for a wound (no indication of the stage is documented) prior to being admitted to facility. In addition, although the complainant alleges R1 was not being rotated there is no evidence of a worsening wound or a developing rash.

(Continued on 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 21-AS-20260303114041
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: 06/02/2026
NARRATIVE
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(Continued from 9099-A)

In addition, there was no evidence of diaper rash or redness due to improper placement of diaper or a developing rash or that R1 was left in soiled diapers as documented in records. Prior to admission R1 did have a diagnosis of breathing issues, as documented in outside records. There is no indication that R1 sustained any new symptoms while at the facility. Therefore the allegations that Staff were not following residents care plan and Staff left resident in soiled diaper for a period of time are UNSUBSTANTIATED. Although the allegations may have occurred there is not a preponderance of evidence therefore the allegations are unsubstantiated.

The complaint alleges that Unqualified staff administering residents medication. Review of staff training records documents that S1 had received the required hours of training per Health and Safety Code 1569.69 therefore the allegation that Unqualified staff were administering residents' medication 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: 06/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 21-AS-20260303114041
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/02/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/02/2026
Section Cited
CCR
87465(a)(5)(A)
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87465(a)(5)Incidental Medical and Dental Care: A plan for incidental medical and dental care...The plan shall encourage routine medical and dental care and provide for assistance...with the following:The licensee shall assist residents...(A) Medications usually prescribed for self-administration which have been authorized by the person's physician. This requirement was not met as evidenced by:
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Executive Director will submit a plan by 6/4/2026 to ensure that all medication technicians review the rules for proper procedures in medication administration and will go through a re-training regarding accurate documentation in the MAR, including the reporting process to CCL for missed medications. Training to be completed by 6/15/2026 and reported to LPA upon completion.
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Based on review of R1's medication administration record (MAR) there was a missed dose on 2/18/26 which is an immediate health, safety and personal rights risk to residents 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: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5