486804191-9-23-2025-21-AS-KMOA-DM3MBA-20251002092737

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486804191
Report Date: 09/23/2025
Date Signed: 09/23/2025 03:04:59 PM

Unsubstantiated

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
06/24/2025 and conducted by Evaluator Jill Nakagawa

COMPLAINT CONTROL NUMBER: 21-AS-20250624103730

FACILITY NAME:	FARMSTEAD AT DIXON, THE		FACILITY NUMBER:	486804191
ADMINISTRATOR:	MARK REYES		FACILITY TYPE:	740
ADDRESS:	350 GATEWAY DRIVE		TELEPHONE:	(707) 676-5060
CITY:	DIXON	STATE: CA	ZIP CODE:	95620
CAPACITY:	96	CENSUS: 52	DATE:	09/23/2025
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Mark Reyes, Administrator		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff violated residents personal rights
Staff did not properly assist a resident during transfers

INVESTIGATION FINDINGS:

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On 9/23/2025 Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to continue an investigation regarding the above allegations. LPA conducted interviews, made observations and reviewed documents. LPA met with Administrator Mark Reyes to discuss the findings.

The complaint alleges that Staff violated resident’s personal rights. The complainant stated that a staff member (S1) pulls a resident’s (R1) arm and tells R1 if they don’t do what S1 says they will get R1 kicked out. LPA interviewed complainant, who stated that there are staff that are not well-trained and should not be working there. LPA reviewed the training and personnel files of S1 and found that S1 is a long-term employe; S1 received all the required training as per regulation.
(Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025

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-20250624103730

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: FARMSTEAD AT DIXON, THE	FACILITY NUMBER: 486804191
	VISIT DATE: 09/23/2025

NARRATIVE

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(Continued from 9099)
LPA interviewed Administrator and S3 who both stated that S1 has never had any complaints against their care of residents. LPA was unable to interview R1. LPA conducted 5 interviews with staff and family member of R1 and found that there were no concerns or complaints from the 5 of 5 interviewees about the care that S1 provided. Based on the statements of interviewees and the service record of S1 the allegation that Staff violated resident’s personal rights is unsubstantiated. Although the allegation may have occurred there is not a preponderance of evidence therefore the allegation that Staff violated resident’s personal rights is UNSUBSTANTIATED

The complaint alleges that Staff did not properly assist a resident during transfers. The complainant states that a caregiver (S2) is responsible for a resident (R2) falling and now has a full cast. LPA reviewed Incident Reports for a reported fall where a resident suffered a fracture and found no such report. LPA interviewed staff members, R2 and family member of R2. 5 of 5 interviewees stated that R2 had not suffered fracture due to fall of 6/21/2025. LPA interviewed R2 and family member of R2 and asked if Staff properly assist R2. They reported that staff assist R2 properly. LPA reviewed the personnel files for S2 and found that S2 had received all necessary trainings and had no disciplinary actions taken. Based on LPA’s review of medical records of S2, review of staff records, and interviews conducted LPA found the allegation that Staff did not properly assist a resident in transfers is unsubstantiated. Although the allegation may have occurred there is not a preponderance of evidence to substantiate the allegation therefore the allegation that Staff did not properly assist a resident in transfers is UNSUBSTANTIATED.

NO DEFICIENCIES FOUND REGARDING THIS INVESTIGATION. NO CITATIONS ISSUED.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025

LIC9099 (FAS) - (06/04)

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