486804153-7-2-2026-21-AS-BMOS-DW8V76-20260722161037

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486804153
Report Date: 07/02/2026
Date Signed: 07/02/2026 12:44:56 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
05/27/2026 and conducted by Evaluator Star Stevenson

COMPLAINT CONTROL NUMBER: 21-AS-20260527161302

FACILITY NAME:	ZION'S HOME		FACILITY NUMBER:	486804153
ADMINISTRATOR:	LOURDES V SOLLER		FACILITY TYPE:	735
ADDRESS:	1965 CLYDE JEAN PLACE		TELEPHONE:	(650) 333-9568
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94533
CAPACITY:	4	CENSUS: 3	DATE:	07/02/2026
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Lourdes Soller - Administrator		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff do not ensure that residents' dietary needs are met

INVESTIGATION FINDINGS:

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On 07/02/2026 Licensing Program Analyst (LPA) Star Stevenson arrived to deliver compliant findings for the above allegation including, staff do not ensure that resident’s dietary needs are met. Community Care Licensing (CCL) received a complaint on 05/27/2026 alleging that staff restrict food from residents by not serving snacks.

During the course of the investigaton, LPA inspected the home, made observations, took photos, conducted interviews and obtained documents.

An interview with complainant revealed conflicting information in which the complainant indicated if they ask for a snack, they will be told that is fine from staff, and that the complainant will often pack snacks at Zion’s home to take with them to their day program. Complainant revealed that snacks were kept both inside the home and in the garage where duplicates of snacks were held in refrigerators and pantries. Complainant indicated snacks are never locked up when asked if staff locked snacks away.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

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-20260527161302

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: ZION'S HOME	FACILITY NUMBER: 486804153
	VISIT DATE: 07/02/2026

NARRATIVE

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Continued from LIC9099-A

**Amended Report***
An LPA review of Special Incident Reports from 04/26/2026 and 05/07/2026 and submitted for both the complainant and C1 shows consistent documentation of the difficulties between the complainant and C1 and the efforts made by the facility to inform families, North Bay Regional Center, Psychiatrists and Behaviorists.

LPA reviewed staffing schedule and staff to client ratio and ratio appears appropriate to provide the necessary care needed.

Because Zion’s home has no staff member by the name indicated on the complaint and because the staff have made efforts to minimize fighting between the complainant and C1 and because staff have made efforts with medical and support staff to minimize fighting between complainant and C1 the above allegation is unsubstantiated.

A finding of unsubstantiated means, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated that the allegation was false, could not have happened and/or is without a reasonable basis.

Report was read to Administrator Lourdes Soller, whose signature her denotes receipt.

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026

LIC9099 (FAS) - (06/04)

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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
05/27/2026 and conducted by Evaluator Star Stevenson

COMPLAINT CONTROL NUMBER: 21-AS-20260527161302

FACILITY NAME:	ZION'S HOME		FACILITY NUMBER:	486804153
ADMINISTRATOR:	LOURDES V SOLLER		FACILITY TYPE:	735
ADDRESS:	1965 CLYDE JEAN PLACE		TELEPHONE:	(650) 333-9568
CITY:	FAIRFIELD	STATE:CA	ZIP CODE:	94533
CAPACITY:	4	CENSUS: 3	DATE:	07/02/2026
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Lourdes Soller - Administrator		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Personal Rights

INVESTIGATION FINDINGS:

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***Amended: Due to further review, finding is being changed from unfounded to UNSUBSTANTIATED on 07/21/2026

On 07/02/2026 Licensing Program Analyst (LPA) Star Stevenson arrived to deliver compliant findings for the above allegation of a Person Rights violation. Community Care Licensing (CCL) received a complaint on 05/27/2026 alleging that a staff member cursed at the complainant.

During the course of the investigation LPA inspected the home, made observations, conducted interviews and obtained documents.

An interview with complainant revealed that it was not a staff member that cursed at the complainant, but rather another client (C1) that lives at Zion’s home.

A review of the Personnel Roster (LIC500) and California Department of Social Services (CDSS) Guardian Roster Report revealed that a staff member of the name, a concerned was raised about by complainant does not work at Zion’s home.
Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026

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 4

Control Number 21-AS-20260527161302

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: ZION'S HOME	FACILITY NUMBER: 486804153
	VISIT DATE: 07/02/2026

NARRATIVE

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Continued on LIC9099

A separate interview with client (C1) had C1 indicating they are allowed snacks at any time, but that pantry snacks might be locked at times, with clients needing to ask for snacks, but clients are never told they cannot have snacks.

In addition, LPA interviewed two staff members, S1 and S2 who both revealed that clients are always allowed snacks which are both set out and/or made available upon request. In addition, interviews with S1 and S2 revealed that client will shop for themselves and will often have their own snacks in their rooms.

LPA noted and took photos of a good supply of unlocked pantry snacks and food, as well as refrigerated snacks, as well as, plated out and sealed meals that staff indicated were made and labeled for clients, but were not consumed with clients feeling too rushed to go to day program to consume.

Because clients have indicated that they have access to snacks and are always given snacks when requested and because LPA observed a good supply and variety of snack upon unannounced inspection and because clients in care appear well nourished, the complaint that staff do not ensure client’s dietary needs are met, is unsubstantiated.

Unsubstantiated means, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

Report was reviewed with Administrator whose signature here denotes receipt.

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

LIC9099 (FAS) - (06/04)

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