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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496802052
Report Date: 07/30/2026
Date Signed: 07/30/2026 12:34:43 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
11/12/2025 and conducted by Evaluator Robert Frank
COMPLAINT CONTROL NUMBER: 21-AS-20251112104209
FACILITY NAME:BETSY'S II RCFEFACILITY NUMBER:
496802052
ADMINISTRATOR:ALICDAN JR, EDWARDFACILITY TYPE:
740
ADDRESS:3101 BRUSH CREEK ROADTELEPHONE:
(707) 537-0399
CITY:SANTA ROSASTATE: CAZIP CODE:
95404
CAPACITY:13CENSUS: 7DATE:
07/30/2026
UNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Luningning Alicdan, LicenseeTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Facility did not seek timely medical care

Wrongful Eviction
INVESTIGATION FINDINGS:
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At approximately 11:05 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to deliver findings regarding the above allegations and met with facility licensee Luningning Alicdan.

During the course of the investigation the Department conducted multiple facility visits, conducted interviews, collected and reviewed documents.

Complaint alleges that the facility did not seek timely medical treatment for a resident in care. During a routine doctor’s appointment on 11/10/2025 residents R1’s doctor noted that resident R1 was not well and contacted staff at Betsy’s II RCFE during the appointment. Staff Member S1 reported that for about one (1) month, resident R1 had not been able to feed themselves or walk. Resident R1 was sent directly from doctor’s office to the emergency room where they were subsequently diagnosed with a fracture and an infection.
Continued on 9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026
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 7
Control Number 21-AS-20251112104209
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: BETSY'S II RCFE
FACILITY NUMBER: 496802052
VISIT DATE: 07/30/2026
NARRATIVE
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...Continued from 9099

Review of medical records indicates that on 11/7/2025, staff member S1 contacted Kaiser and reported that resident R1 had trouble walking for about two weeks. Prior to R1’s appointment on 11/10/2025, when witness W1 arrived at the facility they noted that resident R1 was “catatonic” and described R1 as being stuck in a seated position even when staff transferred R1 to the car from a wheelchair. During this transfer, R1 stated, “ow, ow, ow”, and R1 appeared to be in pain. Facility staff contacted witness W1 approximately one (1) week prior to the 11/10/2025 doctor’s appointment because resident R1 had swollen feet. Facility staff reported no other concerns. The facility staff had not notified W1 of resident R1 having any changes in condition or falls. During interview, staff member S2 stated they were not aware of resident R1 having any falls. This statement was contradicted by the fact that staff member S1 stated that they reported to S2 that resident R1 had a fall (but were not hurt by the fall) within their last six (6) months of care. During interview, Staff member S3 stated they were told by other staff members of resident R1 having had two (2) falls. Staff member S3 stated that they were not present at the time of the two (2) falls. Staff member S3 further stated they wanted to call 9-1-1 and have resident R1 sent out because they could tell that R1 was injured and in pain. Staff members S1 and S4 would not let staff member S3 call 911.

Based on interviews and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 Chapter 8, are being cited on the attached 9099Ds.
Administrator/Licensee was informed that civil penalties are under review by the Department per Health and Safety Code 1569.49(f), 1548, or 1568.0822

Complaint alleges wrongful eviction. Facility resident R1 was taken to Kaiser Hospital on 11/10/2025. Staff at Kaiser called the facility to arrange for resident R1 to return to the facility. At this time, witness W2 was told by facility staff that R1 cannot return to the facility as the facility is being sold.

Continued on 9099-C2
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 21-AS-20251112104209
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: BETSY'S II RCFE
FACILITY NUMBER: 496802052
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/30/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/31/2026
Section Cited
CCR
87465(a)(1)
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87465 Incidental Medical and Dental Care (a) A plan...The plan shall encourage...obtaining such care, by compliance... (1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement is not met as evidenced by:
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Licensee will provide training for all staff members, on all shifts in Psychosocial and Physical needs of the elderly, Physical Environment and resident rights and will further provide training in California Code of Regulations 87465
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Based on interview & record review, the licensee did not comply with the section cited above in that staff did not seek timely medical care for resident R1 which poses an immediate health, safety or personal rights risk to persons in care.
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Incidental Medical and Dental Care to all staff members. Proof of all training to be submitted to Community Care Licensing by POC due date of 7/31/2026.
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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: Robert Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 21-AS-20251112104209
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: BETSY'S II RCFE
FACILITY NUMBER: 496802052
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/30/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/13/2026
Section Cited
CCR
87466
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87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes...When changes...are observed,...brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidenced by:
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Facility to update their plan to ensure communication on all shifts related to residents in care and any/all changes of condition. Facility to provide a copy of the updated plan along with a roster of staff trained on new plan by POC due date of 8/13/2026.
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Based on interview & record review, the licensee did not comply with the section cited above in that staff did not report changes in the health condition for R1 to R1’s responsible party which poses a potential health, safety or personal rights risk to persons in care.
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Type B
08/13/2026
Section Cited
CCR
87468.2(20)
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87468.2 Additional Personal Rights... (20) To be protected from involuntary...evictions. A licensee shall not...evict residents for reasons other than those permitted by state law..."involuntary" means...eviction that is initiated by the licensee, not by the resident.
This requirement is not met as evidenced by:
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Licensee to submit an LIC 9098 Self Certification that they have read and understand California Code of Regulations (CCR) 87224 Eviction Procedures and CCR 87468.2 Additional Personal Rights of Residents in Privately Operated Facilities to CCL by POC due date of 8/13/2026.
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Based on interview and express admission, the licensee did not comply with the section cited above in that resident R1 was not allowed to return to the facility from a doctors appointment which 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: Robert Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 21-AS-20251112104209
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: BETSY'S II RCFE
FACILITY NUMBER: 496802052
VISIT DATE: 07/30/2026
NARRATIVE
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...Continued from 9099-C

During a facility visit on 11/13/2026 facility licensee Luningning Alicdan made the following unsolicited statements, “I told Kaiser we would not take them (R1) back.” Licensee Alicdan further stated, “I told the nurse I am not going to take them (R1) back as they (R1) have a better chance of getting the government to help them. It’s up to the social worker at Kaiser to find help for them (R1) in the community.” Resident R1 did not return to the facility on or after 11/10/2026.

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

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Exit interview conducted. Copy of report, LIC-9099, LIC-9099-C, LIC-9099C-2 LIC-9099Ds, LIC-811 Confidential Names Plan of Corrections and Appeal Rights discussed and provided to Licensee Alicdan. Signature on form confirms receipt of documents.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 7
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
11/12/2025 and conducted by Evaluator Robert Frank
COMPLAINT CONTROL NUMBER: 21-AS-20251112104209

FACILITY NAME:BETSY'S II RCFEFACILITY NUMBER:
496802052
ADMINISTRATOR:ALICDAN JR, EDWARDFACILITY TYPE:
740
ADDRESS:3101 BRUSH CREEK ROADTELEPHONE:
(707) 537-0399
CITY:SANTA ROSASTATE:CAZIP CODE:
95404
CAPACITY:13CENSUS: 7DATE:
07/30/2026
UNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Luningning Alicdan, LicenseeTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Resident sustained unexplained fracture
INVESTIGATION FINDINGS:
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At approximately 11:05 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to deliver findings regarding the above allegation and met with facility licensee Luningning Alicdan.

During the course of the investigation the Department conducted multiple facility visits, conducted interviews, collected and reviewed documents.

Complaint alleges Resident R1 sustained unexplained fracture, Staff member S1 stated they found resident R1 on the floor one morning when they arrived for their shift on an undisclosed date. Staff member S1 did not know how resident R1 had fallen. Staff member S1 denied that resident R1 has had any other (previous) falls. Staff member S1 was told by resident R1’s roommate that R1 had been on the floor for about five (5) minutes before they arrived.

Continued on 9099A-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 21-AS-20251112104209
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: BETSY'S II RCFE
FACILITY NUMBER: 496802052
VISIT DATE: 07/30/2026
NARRATIVE
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...Continued from 9099-A

Staff member S3 was told by staff member S1 and staff member S4 that resident R1 had previously fallen two (2) times; however, staff member S3 did not have any additional details of the two (2) previous falls. The time frames for the falls are unknown. Staff members S2, S3 and other staff interviewed denied any knowledge of resident R1 having a fall.

So, 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, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted. Copy LIC-9099A, LIC-9099A-C discussed and provided to Licensee Alicdan. Signature on form confirms receipt of documents.

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

DATE: 07/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026
LIC9099 (FAS) - (06/04)
Page: 7 of 7