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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496804280
Report Date: 09/11/2025
Date Signed: 09/11/2025 02:11:35 PM

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
09/10/2025 and conducted by Evaluator Dina Alviso
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20250910082154
FACILITY NAME:PINE RIDGE TERRACEFACILITY NUMBER:
496804280
ADMINISTRATOR:TAPIA, KARINAFACILITY TYPE:
740
ADDRESS:300 FOUNTAINGROVE PARKWAYTELEPHONE:
(707) 566-8600
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY:110CENSUS: DATE:
09/11/2025
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Karina Tapia-AdministratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
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9
Staff touched resident in an inappropriate manner
INVESTIGATION FINDINGS:
1
2
3
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5
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8
9
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11
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13
Licensing Program Analyst (LPA) Alviso conducted a complaint inspection, on 9/11/25 at approximately 10:20am, and met with Administrator Karina Tapia, and Cheyenne Flores, LVN/Health Services Director.

Reporting party alleges “staff touched resident in an inappropriate manner “. LPA interviewed staff, Administrator Karina Tapia. The investigation revealed that resident (R1) is not a resident of the assisted living residential care facility for the elderly-license #496804280. R1 was identified by name to have been a patient in the skilled nursing facility building across from the assisted living building. The Arbol skilled nursing facility is not part of the assisted living license. LPA will cross report, reporting party’s information/allegations to the appropriate investigating agency, the CA Department of Public Health.

Per LPA’s investigation, the allegation of “staff touched resident in an inappropriate manner” is Unfounded, R1 is not a resident of Pine Ridge Terrace assisted living. The Department/Community Care Licensing has no jurisdiction over the Arbol Skilled Nursing Care facility.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
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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