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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496803929
Report Date: 09/18/2025
Date Signed: 09/18/2025 10:38:34 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
07/14/2025 and conducted by Evaluator Marisol Cuadra
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20250714133736
FACILITY NAME:MAGGIE'S CARE HOMEFACILITY NUMBER:
496803929
ADMINISTRATOR:GARCIA, HEHERSON MFACILITY TYPE:
740
ADDRESS:916 RENEE COURTTELEPHONE:
(707) 293-9833
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY:6CENSUS: 3DATE:
09/18/2025
UNANNOUNCEDTIME BEGAN:
08:44 AM
MET WITH:Heherson Garcia (Licensee)TIME COMPLETED:
10:53 AM
ALLEGATION(S):
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-Facility not administering medication as prescribed.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marisol Cuadra arrived unannounced to conduct a complaint investigation and deliver findings regarding the allegation listed above and met with Licensee Heherson Garcia.

The Department received an allegation of facility not administering medication as prescribed. Per Reporting Party, there are concerns about the facility giving the appropriate medication dosage to a resident (R1) as prescribed. Based on interviews conducted with the Licensee, R1 had a doctor's order dated 5/30/25 where Olanzapine 5mg, was increased to 7.5 mg. However, R1 is taking only 2 tablets, totaling 5mg and their physician was considering the possibility of increasing back to the original prescription of 3 tablets totaling 7.5mg of olanzapine, but the increase has raised concerns due to ongoing issues of Urinary Tract Infection (UTI) because of previous dosage increases.

Continue on LIC9099C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
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 4
Control Number 21-AS-20250714133736
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: MAGGIE'S CARE HOME
FACILITY NUMBER: 496803929
VISIT DATE: 09/18/2025
NARRATIVE
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Continued from LIC9099...

Based on LPA’s record review of R1’s medications indicates that on 5/30/2025 R1 had a prescribed Olanzapine 5mg order to take two tablets daily at bedtime, dosage was decreased given urinary retention to Olanzapine 2.5mg to take 3 tablets by mouth daily at bedtime. On 7/8/25 there was a change of dosage to Olanzapine 5mg to take 1 tablet daily at bedtime. However, MARs provided for R1 including the months of June and July 2025, revealed that R1’s medication indicates: Olanzapine 5mg “take 1 tablet by mouth daily at bedtime”, which it was given to R1 not reflecting medication changes above prescribed. Based on LPA’s interviews conducted with the Licensee, information obtained supports that facility was aware of medication changes and did not perform adjustments to R1’s medication due to Licensee was confused regarding proper dosage to be provided to R1. 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), is cited on the attached LIC 9099D. Appeal Rights Given.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 21-AS-20250714133736
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: MAGGIE'S CARE HOME
FACILITY NUMBER: 496803929
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/19/2025
Section Cited
CCR
87465(c)
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Type A - 87465 (c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication...the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by:
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The facility have conducted all staff training regarding the medication changes. The Licensee will review regulation and will submit self-certification LIC9098 to CCL by POC due date.
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Based on records review and interviews with Licensee, there is a written order from a physician dated 5/30/25 increasing Olanzapine 5mg order to take two tablets daily at bedtime was decreased given urinary retention to Olanzapine 2.5mg to take 3 tablets by mouth daily at bedtime, but it was revealed that no adjustments were performed by the Licensee, which poses an immediate risk to the health and safety of clients 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.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
07/14/2025 and conducted by Evaluator Marisol Cuadra
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20250714133736

FACILITY NAME:MAGGIE'S CARE HOMEFACILITY NUMBER:
496803929
ADMINISTRATOR:GARCIA, HEHERSON MFACILITY TYPE:
740
ADDRESS:916 RENEE COURTTELEPHONE:
(707) 293-9833
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY:6CENSUS: 3DATE:
09/18/2025
UNANNOUNCEDTIME BEGAN:
08:44 AM
MET WITH:Heherson Garcia (Licensee)TIME COMPLETED:
10:53 AM
ALLEGATION(S):
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-Personal Rights.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a complaint investigation and deliver findings regarding the allegation listed above and met with Licensee Heherson Garcia.
Regarding allegation of Personal Rights. The Reporting party has concerns about the emotional well-being of a resident (R1) at this facility. On 7/17/25, LPA conducted a 10-day visit to the facility, made observations, reviewed records and conducted interviews with staff and residents in care. Based on records review, R1 is non-ambulatory and has some cognitive challenges along with other medical conditions including specialized diet, needs assistance with some activities (ADLs) of self-care, R1 requires supervision due to their exposure to certain items which could result in health and safety risk, but R1 is able to communicate their needs. R1’s care plan confirmed ongoing issues of UTI, specialized diet, medication management and ADL care needs. Interviews conducted by LPA with staff and R1 did not indicate any supporting evidence that R1’s personal rights violation occurred at a prior date, R1 stated that they feel safe at home and their needs are being met by the facility staff. A finding that the complaint allegation occurs of personal rights is 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, therefore the allegation is UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4