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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496804150
Report Date: 10/23/2025
Date Signed: 10/23/2025 01:58:36 PM

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
09/24/2025 and conducted by Evaluator Shannan Hansen
COMPLAINT CONTROL NUMBER: 21-AS-20250924120527
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: 79DATE:
10/23/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:John Beltz, Administrator TIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff does not provide food alternatives for residents with medical prescribed diets
Staff do not provide food alternatives for residents with religious, cultural beliefs
Staff does not ensure food is stored at appropriate temperatures prior to being served to residents in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Hansen arrived unannounced to deliver complaint findings of an investigation conducted regarding the allegations listed above. LPA met with Administrator John Beltz.
During the course of the investigation 2 visits (10/2/25 & 10/23/2025) making observations, documents obtained of; admissions agreements, medical/dietary document along with menus of 5-week increments, and 6 resident along with 4 staff interviews were conducted.

Staff does not provide food alternatives for residents with medical prescribed diets & Staff do not provide food alternatives for residents with religious, cultural beliefs - Complainant alleges facility never accommodates special dietary needs that were prescribed by physician, and facility does not provide a meal substitute for religious/cultural beliefs e.g..pork. Investigation revealed on 10/2/2025 when LPA went to facility to open complaint at approximately 8 am, observed residents eating many different breakfast options that included; fried egg and hashbrowns, freshly cut strawberries and blueberries, oatmeal, heart healthy cereal, & Belgian waffles. Continue on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Shannan Hansen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
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-20250924120527
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: 10/23/2025
NARRATIVE
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Continued from LIC9099:

Of the 5 residents interviewed, 3 had dietary physician orders, none of the 3 residents indicated there was any problem with the food they received from the facility regarding their special diets or getting alternatives for the meals. Resident (R5) indicated the facility keeps low sodium food due to the residents’ age, and the facility is following their dietary restrictions regarding salt. R5 likes the soups offered by the facility and indicated they believe most of the residents think the food is OK, just repetitious. R6, with a diabetic diagnosis indicated they have no problem with any of the food or options. Just that sometimes they eat upstairs but they like eating in the dining room where they can see more of the options. Interview with Staff (S2) revealed the facility has a dietitian, which was corroborated by Administrator who indicated the facility is contracted with a dietitian that visits several times a year and provides oversight with any menu changes. LPA’s review of 5-week rotational menu showed each of the 3 main meals per day has a full meal substitute with at least 3 to 4 main substitutes not being of pork and having low salt/low carb/ being diabetic friendly. Admissions agreement does not indicate anywhere facility must store or cook personal food. There was no information obtained that supported a violation had occurred.

Based on the interviews, record reviews, and related information obtained during the investigation, the allegations “Staff does not provide food alternatives for residents with medical prescribed diets” & “Staff do not provide food alternatives for residents with religious, cultural beliefs” 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.

Staff does not ensure food is stored at appropriate temperatures prior to being served to residents in care- Reporting party also indicated observing staff at the facility serving potato salad to residents and the potato salad would be served in a plastic bowl and it would already be warm. LPA’s interview with S1 revealed for residents who eat in their rooms the kitchen staff will cover the hot foods and put on a tray and will put the cold food in a container on the tray separating them. LPA’s 2 visits (10/2/2025 & 10/23/2025 ) to facility during both breakfast and lunchtime did not observe any food that should be cold left out and warm. Interviews with 3 residents regarding temperature of food revealed regardless of where they eat their meals the temperature of the food is appropriate. There was no information obtained to support a violation occurred. Therefore, the allegation staff does not ensure food is stored at appropriate temperatures prior to being served to residents in care is Unsubstantiated, meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Shannan Hansen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2