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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486804012
Report Date: 07/27/2026
Date Signed: 07/27/2026 04:40:57 PM

Substantiated


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
05/05/2026 and conducted by Evaluator Ali Deniz
COMPLAINT CONTROL NUMBER: 21-AS-20260505083955
FACILITY NAME:HAVEN'S HOUSE OF ASSISTED LIVINGFACILITY NUMBER:
486804012
ADMINISTRATOR:THOMAS, APRILFACILITY TYPE:
740
ADDRESS:2769 BRADBURY WAYTELEPHONE:
(415) 374-5703
CITY:FAIRFIELDSTATE: CAZIP CODE:
94534
CAPACITY:6CENSUS: DATE:
07/27/2026
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Licensee/Administrator April ThomasTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Physical Abuse.
Financial Abuse.
INVESTIGATION FINDINGS:
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On 07/27/2026, an office meeting was conducted at the Santa Rosa Regional Office. The following individuals were present in the meeting: Regional Manager (RM), Carla Nuti-Martinez, Licensing Program Manager (LPM), Bethany Moellers, Licensing Program Analysts (LPA), Ali Deniz, and Licensee/Administrator April Thomas. During the meeting LPA was able to deliver findings for a Complaint Investigation regarding the above allegations.

During the course of the investigation, the Department requested and reviewed documents, conducted interviews, and made observations. The following allegation was investigated, “Physical Abuse and Financial Abuse.”

• Physical Abuse
The complaint alleged that the Licensee physically abused residents. The Reporting Party (RP) stated that while assisting Resident 1 (R1) with care, the Licensee bent R1’s arm, causing R1 to state, “Ow April, you are hurting me.”
Continued on LIC9099-C page...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2026
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-20260505083955
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: HAVEN'S HOUSE OF ASSISTED LIVING
FACILITY NUMBER: 486804012
VISIT DATE: 07/27/2026
NARRATIVE
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Continued from LIC9099 page...
RP further reported that the Licensee waved a closed fist in front of R1’s face and that R1 disclosed the Licensee hits residents.

During the investigation, LPA conducted interviews with residents and staff, made observations, and reviewed available documentation. Two staff members reported that the Licensee has been rough with residents and frequently yells at residents and staff. On 07/24/2026, LPA and LPM observed the Licensee speaking loudly to residents and arguing with residents regarding food.
During an interview, a resident reported to LPA that the Licensee pushed them. Additionally, during an interview with LPM, the Licensee stated that she grabbed a resident by the wrist and pried the resident’s fingers from a doorway.
Based on interviews, observations, and the Licensee’s statements, the allegation is Substantiated.

• Financial Abuse
The complaint alleged that the Licensee misused residents’ financial resources, including EBT benefits, IHSS funds, and resident checks. The Reporting Party (RP) stated that R1 reported the Licensee was taking R1’s checks and that although R1 had received six checks and never received the funds.
During the investigation, LPA conducted interviews with residents and staff. Interviews confirmed that the Licensee maintains control of resident checks until rent payments are received. Interviews also indicated that the Licensee utilizes residents’ EBT benefits and IHSS funds to subsidize facility expenses.
Based on interviews and review of available information, the allegation is Substantiated.

Based on observations, interviews, and record review, the allegations are 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 deficiencies, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Exit interview conducted. Copy of report, LIC9099D (Deficiency Page), Plan of Corrections, and Appeal Rights discussed and provided to Executive Director/Administrator. Signature on form confirms receipt of documents.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 21-AS-20260505083955
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: HAVEN'S HOUSE OF ASSISTED LIVING
FACILITY NUMBER: 486804012
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/28/2026
Section Cited
CCR
87468.1(a)(3)
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87468.1(a)(3) Personal Rights of Residents in All Facilities: (a)(3) To be free from punishment,humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’...
This requirement was not met as evidenced by:
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The Licensee agrees to complete a self-certification on physical abuse, financial abuse, and resident rights. The Licensee will submit proof of completion of the self-certification to Community Care Licensing by the Plan of Correction (POC) due date of 07/28/2026.
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Based on interviews conducted, records reviewed, and observations made, the facility failed to ensure resident’s rights and protection from abuse. This poses a potential health, safety or personal rights 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.
SUPERVISOR'S NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 21-AS-20260505083955
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: HAVEN'S HOUSE OF ASSISTED LIVING
FACILITY NUMBER: 486804012
VISIT DATE: 07/27/2026
NARRATIVE
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Continued from LIC9099-A page...

During the initial visit on 05/06/2026, LPA observed that all resident bedding was in compliance with regulatory requirements. LPA also observed additional bedding supplies stored in the facility closet. During an interview, the Licensee stated that the facility provides and cleans resident bedding as needed. LPA was unable to obtain additional information regarding this allegation.
Based on observations and interviews, 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 Executive Director. Signature on form confirms receipt of documents.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2026
LIC9099 (FAS) - (06/04)
Page: 5 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
05/05/2026 and conducted by Evaluator Ali Deniz
COMPLAINT CONTROL NUMBER: 21-AS-20260505083955

FACILITY NAME:HAVEN'S HOUSE OF ASSISTED LIVINGFACILITY NUMBER:
486804012
ADMINISTRATOR:THOMAS, APRILFACILITY TYPE:
740
ADDRESS:2769 BRADBURY WAYTELEPHONE:
(415) 374-5703
CITY:FAIRFIELDSTATE:CAZIP CODE:
94534
CAPACITY:6CENSUS: DATE:
07/27/2026
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Licensee/Administrator April ThomasTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
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9
Facility is not provided required bedding.
INVESTIGATION FINDINGS:
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On 07/27/2026, an office meeting was conducted at the Santa Rosa Regional Office. The following individuals were present in the meeting: Regional Manager (RM), Carla Nuti-Martinez, Licensing Program Manager (LPM), Bethany Moellers, Licensing Program Analysts (LPA), Ali Deniz, and Licensee/Administrator April Thomas. During the meeting LPA was able to deliver findings for a Complaint Investigation regarding the above allegations.

During the course of the investigation, the Department requested and reviewed documents, conducted interviews, and made observations. The following allegation was investigated, “Facility is not provided required bedding.”

The complaint alleged that the facility failed to provide required bedding to residents and ask them to purchase their own bedding.
Continued on LIC9099-C page...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5