<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 490108000
Report Date: 08/07/2026
Date Signed: 08/07/2026 09:58:50 AM

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
06/18/2026 and conducted by Evaluator Robert Frank
COMPLAINT CONTROL NUMBER: 21-AS-20260618141658
FACILITY NAME:MC HUGH CARE HOMEFACILITY NUMBER:
490108000
ADMINISTRATOR:DIZON, JASMINEFACILITY TYPE:
740
ADDRESS:1000 GORDON LANETELEPHONE:
(707) 545-8213
CITY:SANTA ROSASTATE: CAZIP CODE:
95404
CAPACITY:15CENSUS: 0DATE:
08/07/2026
ANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Tiffany Dizon, LicenseeTIME COMPLETED:
10:10 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident was denied food by the facility staff

Facility staff yell at the resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At approximately 9:30 AM, Licensing Program Manager (LPM) Victoria Bertozzi and Licensing Program Analyst (LPA) Robert Frank arrived to deliver Complaint findings regarding the above allegations and met with Licensee Tiffany Dizon.

During the course of the investigation LPA conducted multiple facility visits, conducted interviews, collected and reviewed documents. Complaint alleges that resident R1 was denied food by the facility staff and that facility staff yell at residents. Witness W3 stated on 6/17/2026 at approximately 4:30 PM, resident R1 was asked by staff member S1 if they wanted their dinner. W3 stated that resident R1 replied that they were not hungry as they were still full from breakfast and lunch. At some point between 6:30 PM and 7:45 PM resident R1 knocked on staff member S1’s door requesting food. Witness W3 stated that staff member S1 was sleeping at that time. Witnesses W1 and W3 stated that staff member S1 yelled at R1 stating the kitchen is closed. S1 further stated that the facility is not a restaurant and that they can’t order food at any time. Continued on 9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2026
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 3
Control Number 21-AS-20260618141658
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: MC HUGH CARE HOME
FACILITY NUMBER: 490108000
VISIT DATE: 08/07/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
...Continued from 9099

Resident R1 was not served dinner on 6/17/2026. When asked what time meals are served, staff member S2 stated, “Breakfast is 7:00 AM to 7:30 AM, but we don’t impose the time. Some (resident) eat breakfast at 10:00 AM. Lunch is from 10:30 AM to 11:00 AM. Dinner is from 4:00 PM to 5:00 PM, but we don’t really enforce the times.” When asked what time the kitchen closes, staff member S1 stated, “dinner starts at 4:00 PM and the kitchen closes at 5:30 PM.” In resident R1’s Admission Agreement, under House Rules, rule number twenty (20) lists the following mealtimes: “Breakfast 7:30 AM, Lunch 11:30 AM, Dinner 4:30 PM. Kitchen is closed promptly at 8:30 PM” Resident R1 requested their meal between 6:30 PM and 7:45 PM, before the 8:30 PM closing time stated in the admissions agreement. Witnesses W1 and W3 provided corroborating statements that staff member S1 yelled at resident R1.

Based on LPA’s interviews and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 Chapter 8, are being cited on the attached 9099D.

Exit interview conducted. Copy of LIC9099, LIC9099C, LIC9099D, Plan of Corrections and Appeal Rights discussed and provided to Licensee Dizon. Signature on form confirms receipt of documents.

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 21-AS-20260618141658
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: MC HUGH CARE HOME
FACILITY NUMBER: 490108000
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/10/2026
Section Cited
CCR
87555(b)(1)
1
2
3
4
5
6
7
87555 General Food Service Requirements (b)The following food service requirements shall apply:(1) Where all food is provided by the facility arrangements shall be made so that each resident has available at least three meals per day. ...
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Facility is closing. Deficiency will be cleared during today's visit.
8
9
10
11
12
13
14
Based on interview & record review, the licensee did not comply with the section cited above that Resident R1 was not provided dinner on 6/17/2026 which poses a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
Type B
08/10/2026
Section Cited
CCR
87468.1(a)(1)
1
2
3
4
5
6
7
87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1)To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Facility is closing. Deficiency will be cleared during today's visit.
8
9
10
11
12
13
14
Based on interview, the licensee did not comply with the section cited above in that staff member S1 yelled at resident R1 which poses a Potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
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: Robert Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3