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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496804150
Report Date: 02/13/2025
Date Signed: 02/13/2025 09:22:44 AM

Unfounded


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
09/09/2024 and conducted by Evaluator Robert Frank
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20240909141913
FACILITY NAME:WINDSONG OF SONOMAFACILITY NUMBER:
496804150
ADMINISTRATOR:JOHN BELTZFACILITY TYPE:
740
ADDRESS:815 WOOD SORREL DRIVETELEPHONE:
(707) 776-2885
CITY:PETALUMASTATE: CAZIP CODE:
94954
CAPACITY:95CENSUS: 77DATE:
02/13/2025
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Elizabeth Alfaro, Business Office DirectorTIME COMPLETED:
09:30 AM
ALLEGATION(S):
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Resident was unlawfully evicted.

Facility overcharged resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Hansen conducted a complaint investigation regarding the allegations listed above. LPAs Frank and Stevenson arrived unannounced on this day for the purpose of delivering findings of the above allegations. LPAs met with Business Office Director (BOD), Elizabeth Alfaro. Administrator John Beltz was not at the facility during today’s visit. Complainant alleges after resident had been in the hospital for 4 days due to pneumonia, on January 11, 2024 resident's physician cleared to return to facility. Complainant indicated the facility communicated to the resident's physician they would not accept the resident back although did not inform the resident or their spouse. When the family called to ask why the resident was not being permitted to return to the facility, Interim Administrator stated it was because the resident needed a level of care that the facility could not provide. The assessment was made without any evaluation of the resident by the facility. Investigation confirmed facility conducted an assessment while resident was outside of the facility. Outside party confirmed resident was observed to be beyond the level of care the facility could provide.
Continued on 9099-C...
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025
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 2
Control Number 21-AS-20240909141913
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: WINDSONG OF SONOMA
FACILITY NUMBER: 496804150
VISIT DATE: 02/13/2025
NARRATIVE
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...Continued from 9099

Interview with responsible party on 2/5/2025 confirmed no eviction notice given or complaints of overcharging. Responsible party also indicated they received all items from resident apartment and are no longer receiving a bill. Per interview with facility there was an outstanding balance for January 2024, which was waived. The investigation did not reveal information to support these allegations. Based on review of documents/records and interviews conducted, this Agency has investigated, the above allegations, resident was unlawfully evicted & facility overcharged resident are UNFOUNDED. A finding that the complaint is UNFOUNDED means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Exit interview conducted. Copy of report discussed and provided to BOD Alfaro. Signature on form confirms receipt of documents.

No deficiencies cited.

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

DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2