486803937-9-10-2026-21-AS-VBEI-DY6NQJ-20260922103958

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803937
Report Date: 09/10/2026
Date Signed: 09/10/2026 12:49:48 PM

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
06/05/2026 and conducted by Evaluator Elias Magdaleno

COMPLAINT CONTROL NUMBER: 21-AS-20260605105706

FACILITY NAME:	WARD RESIDENTIAL CARE HOME I		FACILITY NUMBER:	486803937
ADMINISTRATOR:	POQUIZ, ALICIA		FACILITY TYPE:	740
ADDRESS:	110 WARD CT		TELEPHONE:	(707) 731-0807
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94589
CAPACITY:	6	CENSUS: 6	DATE:	09/10/2026
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Alicia Poquiz, Administrator		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility is not meeting resident's care needs
Personal Rights

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Magdaleno arrived unannounced to deliver findings regarding the above allegations and met with Administrator Alicia Poquiz.

LPA made observations, gathered documents, and conducted interviews.

Facility is not meeting resident's care needs – Reporting Party (RP) alleges that staff would not assist resident (R1) with transfers or bathing and would not feed R1 for multiple days. Interviews with management indicate that R1 was given “the best care” while at the facility, however, R1 was only at the facility for a short period of time and would often call emergency services to be taken to the hospital. LPA toured facility kitchen and found a sufficient amount of food in good condition as well as a weekly menu with mealtimes visibly posted.

Continued LIC9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Elias Magdaleno
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2026

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-20260605105706

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: WARD RESIDENTIAL CARE HOME I	FACILITY NUMBER: 486803937
	VISIT DATE: 09/10/2026

NARRATIVE

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Continued LIC9099...

Interviews with staff indicated that R1 would often request food at all times of the night and staff would supply it whenever requested. Further interviews with staff indicated that they provided R1 with care per their needs and whenever requested, however, R1 would often become agitated and would refuse care instead calling for emergency services. Staff also indicated that R1 would refuse bathing and medications before forgetting these refusals and accusing staff of not providing them. Staff prompt residents should they refuse but will not force them. Interviews with residents indicated meals are sufficient and care is given when needed. Residents interviewed indicated they have not witnessed staff refusing to provide care to any residents. Further interviews with residents indicated that medications are distributed as prescribed or when needed.

Personal Rights – RP alleges that R1 was placed on Hospice services without R1’s knowledge or consent. Interviews with Management and staff indicated that R1 was placed on Hospice while in the hospital prior to moving into the facility. Review of Preappraisal indicated that R1 was assessed prior to move in and was already on Hospice care. Review of Physician Report and Admission Agreement indicated R1 was receiving Hospice care before moving into the facility.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

No deficiencies cited. Exit interview conducted with Administrator, whose signature on form confirms receipt.

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Elias Magdaleno
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2026

LIC9099 (FAS) - (06/04)

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