496802026-5-21-2025-21-AS-BMOS-DKNVBE-20250818161721

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496802026
Report Date: 05/21/2025
Date Signed: 05/21/2025 05:49:01 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
04/07/2025 and conducted by Evaluator Dina Alviso

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20250407104217

FACILITY NAME:	VILLA CAPRI		FACILITY NUMBER:	496802026
ADMINISTRATOR:	CORTES, MARIA		FACILITY TYPE:	740
ADDRESS:	1397 FOUNTAINGROVE PKWY		TELEPHONE:	(707) 526-9090
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95403
CAPACITY:	80	CENSUS: 65	DATE:	05/21/2025
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Maria Cortes-Administrator		TIME COMPLETED:	05:45 PM

ALLEGATION(S):

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Staff do not ensure that resident's bathing needs are met
Staff do not ensure resident has access to assistive devices

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alviso conducted a complaint inspection, on 5/21/2025 at approximately 9:45am, and met with Administrator Maria Cortez, and Gao Yang Memory Care Director.

Reporting party alleges that staff do not ensure that resident's bathing needs are met, staff do not ensure resident has access to assistive devices, facility staff are not providing resident's medication dosage as prescribed, and facility staff have not requested required medication refills. LPA toured the facility memory care. LPA reviewed R1's records. including care plan, medical assessment, medication records, and admission documents. The LPA conducted interviews with staff, S1, S2, S4, S5, S6, S7, and interviews with other related parties.

The investigation revealed that resident, R1 has refused to be bathed by care staff at times; Per interviews, and record reviews, staff would offer bathing to the resident more than once, and if the resident still refuses the staff try again the next day. R1 gets one (1) shower a week per care plan, and if there is an incident and/or accident requiring bathing of R1, this is provided by the staff, as needed.
Continued on LIC9099C..

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025

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-20250407104217

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: VILLA CAPRI	FACILITY NUMBER: 496802026
	VISIT DATE: 05/21/2025

NARRATIVE

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Responsible party (s) is notified, if R1 refuses bathing as scheduled/as needed, per review of records and interviews. R1’s responsible party (RP) has been notified of resident’s refusal to bathe, and RP has come in to help assist with R1 being bathed. Per record review, on one occasion, R1 refused bathing assistance by RP, but the next day R1 agreed to being bathed by RP. Per interviews, review of records, and observations, staff offer R1 the use of their walker when R1 is observed ambulating without the walker. Staff will offer R1’s glasses to the resident if they observe the resident without them, per interviews. Residents in memory care can move around freely, and staff monitor groups of residents, and check on residents as needed and/or required, per interviews. R1 is not a one-to-one staffed resident and/or assessed as needing one to one staffing at this time. There was differing information obtained during the investigation regarding allegations; There was no information obtained to support that violations had occurred.

Based on the interviews, record/document reviews, and related information obtained during the investigation, the allegation "staff do not ensure that resident's bathing needs are met, and staff do not ensure resident has access to assistive devices” are Unsubstantiated, meaning 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.

No deficiencies cited.
Exit interview was conducted with the Administrator Maria Cortes.

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025

LIC9099 (FAS) - (06/04)

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