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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486804008
Report Date: 09/02/2025
Date Signed: 09/02/2025 10:52:07 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
07/23/2025 and conducted by Evaluator Elias Magdaleno
COMPLAINT CONTROL NUMBER: 21-AS-20250723095135
FACILITY NAME:ALF SANCTUARY ADULT RESIDENTIAL CAREFACILITY NUMBER:
486804008
ADMINISTRATOR:MARIA BUNAFACILITY TYPE:
740
ADDRESS:521 SARAH WAYTELEPHONE:
(707) 759-5392
CITY:SUISUN CITYSTATE: CAZIP CODE:
94585
CAPACITY:6CENSUS: 5DATE:
09/02/2025
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Maria Buna, AdministratorTIME COMPLETED:
11:05 AM
ALLEGATION(S):
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Staff did not provide copy of admission agreement to authorized representative
Staff did not do a proper reassessment for a level change
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elias Magdaleno arrived unannounced for the purpose of delivering findings on the above complaint allegations and met with Maria Buna, Administrator.

During this investigation LPA made observations, reviewed records, and conducted interviews.

Staff did not provide copy of admission agreement to authorized representative – Complainant alleges that facility did not provide a copy of Admission Agreement to resident authorized representative (AR) upon request. Review of email sent by facility to AR indicated that a section of the Admission Agreement was sent to AR via email. Interview with Administrator indicated that Administrator believed that this section was what AR was requesting, not the full document. Administrator also stated that it is facility policy to provide copies of legal or confidential documents to residents, documented responsible parties, or POA only.

Continued LIC9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Elias Magdaleno
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2025
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 3
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
07/23/2025 and conducted by Evaluator Elias Magdaleno
COMPLAINT CONTROL NUMBER: 21-AS-20250723095135

FACILITY NAME:ALF SANCTUARY ADULT RESIDENTIAL CAREFACILITY NUMBER:
486804008
ADMINISTRATOR:MARIA BUNAFACILITY TYPE:
740
ADDRESS:521 SARAH WAYTELEPHONE:
(707) 759-5392
CITY:SUISUN CITYSTATE: CAZIP CODE:
94585
CAPACITY:6CENSUS: 5DATE:
09/02/2025
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Maria Buna, AdministratorTIME COMPLETED:
11:05 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not inform authorized representative of residents change in condition
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Elias Magdaleno arrived unannounced for the purpose of delivering findings on the above complaint allegations and met with Maria Buna, Administrator.

During this investigation LPA made observations, reviewed records, and conducted interviews.

Staff did not inform authorized representative of residents change in condition – Complainant alleges that facility did not inform the residents authorized representative (AR) of residents change of condition. Review of email “(Resident) level of care has greatly increased due to worsening and new exhibited behaviors” sent to AR indicated that AR was sent a clear and detailed list of new behaviors and need for a level of care change for resident by facility six (6) days before rate was increased. Review of Admission Agreement indicated that responsible parties will be informed of rate of change due level of care increase within two (2) business days after level of care increase. We have found that the complaint allegation was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.
No deficiencies cited. Exit interview conducted with Administrator, whose signature on form confirms receipt.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Elias Magdaleno
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2025
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 3
Control Number 21-AS-20250723095135
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: ALF SANCTUARY ADULT RESIDENTIAL CARE
FACILITY NUMBER: 486804008
VISIT DATE: 09/02/2025
NARRATIVE
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Continued from LIC9099...

Staff did not do a proper reassessment for a level change – Complainant alleges that facility charged resident responsible party an increase for level of change without reassessment of resident. Review of email “(Resident) level of care has greatly increased due to worsening and new exhibited behaviors” provided by AR indicated that facility sent a clear and detailed list of new behaviors and need for a level of care change for resident to AR via email. Letter included a new total cost of rate, section of Admission Agreement stipulating rate changes due to level of care change, and letter was provided six (6) days in advance of rate increase.

Based upon observations, interviews, and record review we have found that 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/complaint is 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: 09/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3