496804150-4-18-2025-21-AS-BMOS-DFXT56-20250421142500

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496804150
Report Date: 04/18/2025
Date Signed: 04/18/2025 09:12:33 AM

Unsubstantiated

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
01/23/2025 and conducted by Evaluator Shannan Hansen

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20250123150458

FACILITY NAME:	WINDSONG OF SONOMA		FACILITY NUMBER:	496804150
ADMINISTRATOR:	JOHN BELTZ		FACILITY TYPE:	740
ADDRESS:	815 WOOD SORREL DRIVE		TELEPHONE:	(707) 776-2885
CITY:	PETALUMA	STATE: CA	ZIP CODE:	94954
CAPACITY:	95	CENSUS: 83	DATE:	04/18/2025
		UNANNOUNCED	TIME BEGAN:	08:10 AM
MET WITH:	John Beltz, Administrator		TIME COMPLETED:	09:30 AM

ALLEGATION(S):

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Staff are not meeting residents’ dietary needs
Staff are not providing adequate food service to residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Hansen arrived unannounced for the purposes of delivering complaint findings to the allegations listed above. LPA met with Administrator John Beltz.

Staff are not meeting residents’ dietary needs – Complainant alleges residents (R1) who have doctor’s order for low sodium diet & is diabetic, alleges everything the facility serves is full of a lot of salt and doesn’t eat sugar or dairy. During the investigation LPA obtained physicians report indicating resident (R1) has an order for specialized diet dated 9/26/2024. Plant based/low sodium/diabetic carb control. Interviews with kitchen personal (S1 & S2) informed they manage a 5-week menu rotation through a dietician service that approves all menus, which are changed regularly but remain balanced and approved by the dietician. Fish is on the menu approximately 3 times per week and rotate the types of fish (ie..,cod, shrimp, salmon). During visit on 1/27/2025 & 4/18/2025 LPA toured the kitchen area and observed plenty of perishable and nonperishable fresh fruits and vegetables for residents in care as well obtained current week (1/20/2025 -1/27/2025) facility menu..
Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Shannan Hansen
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2025

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-20250123150458

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: WINDSONG OF SONOMA	FACILITY NUMBER: 496804150
	VISIT DATE: 04/18/2025

NARRATIVE

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Continue from LIC9099

..that offers fresh cut seasonal fruit at every breakfast, diabetic friendly, low sodium, low calorie, low to no sugar lunch including House Salads. Dinners also offer Diabetic-Friendly, low sodium, low calorie, low to no sugar, House Garden Salads with other options. Based on interviews conducted with residents R1 disclosed they provide outside food items of their preference to facility kitchen staff to prepare for them. According to LPA’s observations, records review, and interviews conducted with staff and residents in care, LPA is unable to determine allegation staff was not meeting residents’ dietary needs at a prior date, finding UNSUBSTANTIATED.

Staff are not providing adequate food service to residents- Complainant alleges the food served at the facility is all prepackaged and full of preservatives, and chemicals. As well, is served semi warm or burnt as with broccoli, boxed mashed potatoes, and dry turkey. LPA's interview with S3 informed Food for Thought meetings conducted monthly with Culinary Services Director provide opportunity for residents to provide feedback regarding the food services at the facility. The Culinary Services Director provides responses to some requests/suggestions immediately but others may take time for research and responds to those by or at the following months food for thought meeting. Based on records reviewed LPA obtained monthly food for thought meetings that confirms the involvement of residents food choices to modify the menu (ie.. romaine lettuce to butter lettuce). LPA conducted walk through of kitchen on 1/27/2025 and 4/18/2025 that appear to be per regulation enough perishable and non-perishable foods (see LIC 812-pics). LPA observed Culinary Services Director preparing each order request that had just been taken, individually, and then taken out to the dining room immediately when meal was just prepared. Therefore, allegation staff are not providing adequate food service to residents is found to be UNSUBSTANTIATED.

Although the allegations may be true, based upon the review of documents, observations made and statements provided, there is not a preponderance of evidence to prove, or disprove, the allegations. Therefore, the complaint is UNSUBSTANTIATED.

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Shannan Hansen
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2025

LIC9099 (FAS) - (06/04)

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