496803049-8-4-2026-21-AS-BMOS-DX9M4R-20260824091709

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803049
Report Date: 08/04/2026
Date Signed: 08/04/2026 05:52:31 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
05/05/2026 and conducted by Evaluator Dina Alviso

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20260505223848

FACILITY NAME:	VARENNA AT FOUNTAINGROVE		FACILITY NUMBER:	496803049
ADMINISTRATOR:	BLAKE, DOUGLAS		FACILITY TYPE:	741
ADDRESS:	1401 FOUNTAINGROVE PKWY		TELEPHONE:	(707) 526-1226
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95403
CAPACITY:	322	CENSUS:	DATE:	08/04/2026
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Brooke Patterson- Administrator		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

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Resident's pendant alarm is not responded to in a timely manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alviso conducted a complaint inspection, on 8/4/26, and met with Administrator, Brooke Patterson, and Executive Director, Derrick Defino.

RP alleges that "resident's pendant alarm is not responded to in a timely manner".

LPA reviewed resident, R1's, records. LPA reviewed facility records. LPA conducted interviews with staff, and other related parties regarding alleged allegation. Per record reviews of pendant alarm systems log, from April 2026 and July 2026, following information was obtained. R1's calls for assistance/care needs, the log showed some specific dates of the pendant alarm response times, by staff, documented as follows: On 4/3=14 mins, 4/12= 14 mins, 4/16=13 mins, 4/17=15 mins, 4/21= 14 mins, 4/22= announced 7 times but received no staff response, 4/29= announced 7 times but received no staff response, 7/12= 14 mins, 7/17=16 mins, and 7/22=17 mins.
Continued on LIC9099C..

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2026

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-20260505223848

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: VARENNA AT FOUNTAINGROVE	FACILITY NUMBER: 496803049
	VISIT DATE: 08/04/2026

NARRATIVE

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The investigation revealed that R1 had some pendant calls for assistance, with their ADLs, that were not answered timely, and two (2) calls for assistance with ADLs that were not responded to by facility staff. Per LPA interviews with administration staff, the direct care staff, including medication -technicians, are trained to respond to resident pendant alarms right away, in a timely manner, at all times.

There is sufficient information obtained to support a violation occurred regarding "resident's pendant alarm is not responded to in a timely manner".

Deficiencies will be cited as follows:

87468.2(a)(4) Additional Personal Rights of Residents in Privately Operated Facilities-To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs, see LIC9099D.

The preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is being cited.

Failure to correct deficiencies by due dates, may result in additional deficiency citations and/or civil penalties being assessed.
Exit interview conducted with Administrator Douglas Blake.
Report provided, including appeal rights.

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2026

LIC9099 (FAS) - (06/04)

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Control Number 21-AS-20260505223848

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: VARENNA AT FOUNTAINGROVE	FACILITY NUMBER: 496803049
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/04/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/21/2026 Section Cited CCR 87468.2(a)(4)	1 2 3 4 5 6 7	87468.2(a)(4) Additional Personal Rights of Residents in Privately Operated Facilities-To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs,	1 2 3 4 5 6 7	Licensee/Administrator to ensure that all residents pendant alarm calls are responded to in a timely manner, and responded to at all times. Ensure the pendant alarms system is in working order for resident R1's unit, ensuring all resident's care needs are being met, as required by care plan, and current needs.
	8 9 10 11 12 13 14	The investigation revealed that R1 had some pendant calls for assistance, with their ADLs, that were not answered timely, and two (2) calls for assistance with ADLs, that were not responded to by facility staff. This is a risk to residents personal rights.	8 9 10 11 12 13 14	Submit plan of future compliance, and staff training with caregivers and all staff that respond to resident's pendant alarms. Training regarding the pendant alarm policyand procedures as well as this regulation requirement. POC due by 8/21/26.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 5

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
05/05/2026 and conducted by Evaluator Dina Alviso

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20260505223848

FACILITY NAME:	VARENNA AT FOUNTAINGROVE		FACILITY NUMBER:	496803049
ADMINISTRATOR:	BLAKE, DOUGLAS		FACILITY TYPE:	741
ADDRESS:	1401 FOUNTAINGROVE PKWY		TELEPHONE:	(707) 526-1226
CITY:	SANTA ROSA	STATE:CA	ZIP CODE:	95403
CAPACITY:	322	CENSUS:	DATE:	08/04/2026
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Brooke Patterson- Administrator		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

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Staff did not allow resident to contract private care services

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alviso conducted a complaint visit, on 8/4/26, and met with Brooke Patterson, Administrator, and Derrick Defino,Executive Director.

Reporting party alleges "staff did not allow resident to contract private care services".

LPA reviewed resident (R1) records, including their admission agreement/contract. The LPA requested copies of resident records, and the Administration staff provided the copies to the LPA. LPA reviewed facility records, and obtained requested copies. LPA conducted interviews with staff, and other related parties regarding the alleged allegation.

The investigation revealed that per R1's contract, Section 4.11, Private Caregivers and Companions-
In the event you require private duty care for a short term illness or injury, you must inform Varenna management in writing. If Varenna does not refer you to a private duty provider within seventy-two (72) hours of your request, then you may hire a private caregiver or companion of your choice if they: (1) first register with Varenna and provide proof of licensure and liability insurance; and (2) comply with all of Varenna's policies and procedures for private caregivers and companions. Registration with Varenna is not an endorsement of the private caregivers or companions by Varenna. You shall select such personnel in your discretion and pay for their services.
Continued on LIC9099....

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 21-AS-20260505223848

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: VARENNA AT FOUNTAINGROVE	FACILITY NUMBER: 496803049
	VISIT DATE: 08/04/2026

NARRATIVE

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Record review of, Facility Policy regarding personal care attendants revealed, "Personal Care Attendants- Residents who desire to use a personal care attendant for extended periods of time may do so with prior approval of the Administrator." Procedure #2 of this Policy states, " Personal Care Attendants from outside agencies may be used if approved by the Administrator. The agency shall ensure a criminal clearance on all staff, health screening, appropriate insurance including liability and workers compensation, proof of appropriate employer tax obligations, including but not limited to withholding of state and federal taxes, payment of disability and unemployment insurance. All appropriate labor laws are to be followed and the personal care attendant supervised by an agency administrator familiar with this assisted living community operations".

Information obtained from resident's (R1's) contract regarding "Private Caregivers and Companions" in section 4.11, and from facility's policy regarding "Personal Care Attendants", did not support that a violation had occurred regarding the alleged allegation "staff did not allow resident to contract private care services".

Based on the investigation, the allegation is Unfounded. We have found that the complaint allegation was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

No deficiencies cited.
Exit interview was conducted with Administrator Brooke Patterson, and Executive Director Derrick Defino. Report provided to Administrator.

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2026

LIC9099 (FAS) - (06/04)

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