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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496803825
Report Date: 02/04/2026
Date Signed: 02/04/2026 01:26:10 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
01/30/2026 and conducted by Evaluator Robert Frank
COMPLAINT CONTROL NUMBER: 21-AS-20260130113942
FACILITY NAME:VINE RIDGE SENIOR LIVINGFACILITY NUMBER:
496803825
ADMINISTRATOR:LUA, CARLAFACILITY TYPE:
740
ADDRESS:247 TREADWAY DRIVETELEPHONE:
(707) 791-4787
CITY:CLOVERDALESTATE: CAZIP CODE:
95425
CAPACITY:99CENSUS: 45DATE:
02/04/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Carla Lua, Executive DirectorTIME COMPLETED:
01:40 PM
ALLEGATION(S):
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Staff did not provide requested records to resident’s representative in a timely manner.
INVESTIGATION FINDINGS:
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At approximately 8:50 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to initiate and deliver a finding for a Complaint Investigation regarding the above allegation and met with facility Executive Director (ED), Carla Lua.

During the course of the investigation LPA conducted a facility visit, conducted interviews, collected and reviewed documents.

Complaint alleges facility staff did not provide requested records to a resident’s representative in a timely manner. On 1/23/2026, a request was emailed to facility ED Carla Lua by a resident’s representative asking for copies of resident R1’s record including Medical Records, R1’s Care Plan, all incident reports (including in house reports) and a phone log of all calls related to R1.

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

DATE: 02/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 21-AS-20260130113942
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: VINE RIDGE SENIOR LIVING
FACILITY NUMBER: 496803825
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/04/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/06/2026
Section Cited
CCR
87468.2(a)(19)
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed...(19)To have prompt access to review all of their records and to purchase photocopies...shall be provided within two (2) business days... This requirement is not met as evidenced by:
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Licensee or Administrator to provide all requested documents to R1's representatives by POC due date of 2/6/2026. Additionally, Licensee or Administrator will submit an LIC 9098 Self Certifying that they have reviewed California Code of Regulations 87468.2
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Based on interview & record review, the licensee did not comply with the section cited above in that R1's representatives were not provided copies of documents in R1's file within the regulated time frame which poses a potential health, safety or personal rights risk to persons in care.
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Additional Personal Rights of Residents in Privately Operated Facilities and California Code of Regulations 87506 Resident Records to Community Care Licensing by POC due date of 2/6/2026.
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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.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 21-AS-20260130113942
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: VINE RIDGE SENIOR LIVING
FACILITY NUMBER: 496803825
VISIT DATE: 02/04/2026
NARRATIVE
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...Continued from 9099

Later in the same day, 1/23/2026, ED Lua responded to the document request stating, “We will follow up once the documentation is compiled and ready for release.” On 1/26/2026 LPA Frank spoke with ED Lua via telephone. ED Lua asked if internal incident reports needed to be provided to residents’ representatives if requested. LPA advised ED Lua to check with their legal counsel. During today's facility visit a copy of California Code of Regulations (CCR) 87211 Reporting Requirements was provided ED Lua. On 1/27/2026, the resident’s representative email ED Lua requesting an update and, “if you were gonna have the documents available for me to pick up today before you leave.” On 1/30/2026 ED Lua sent an email to the resident’s representative stating, “This email is to formally clarify our position regarding your request for records from R1’s file. Pursuant to California RCFE regulations (Title 22) and upon advice of legal counsel, we will not release any resident records unless and until we receive a certified written request that clearly identifies: 1. The specific documents being requested. Once a compliant certified request and proper authorization are received, we will review and release only those records that are legally permissible under state regulations. Until that time, no documents will be released. Any further requests should be submitted in writing and in compliance with the above requirements,”. Title 22, Division 6, Chapter 8, Article 08. 87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a)(19) states: (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (19)To have prompt access to review all of their records and to purchase photocopies of their records. Photocopied records shall be provided within two (2) business days and at a cost that does not exceed the community standard for photocopies. The documents requested were not provided within the regulated time. Based on LPA’s 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 LIC9099D.

Exit interview conducted. Copy of LIC9099, LIC9099C, LIC9099D, Plan of Corrections, 811 Confidential Names and Appeal Rights discussed and provided to ED Lua. LPA also provided ED Lua copies of California Code of Regulations (CCR) 87211 Reporting Requirements, CCR 87468.2 Additional Personal Rights of Residents in Privately Operated Facilities and CCR 87506 Resident records for future reference. Signature on form confirms receipt of documents.

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

DATE: 02/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3