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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496804294
Report Date: 07/09/2026
Date Signed: 07/09/2026 09:43:54 AM

Substantiated


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
04/14/2026 and conducted by Evaluator Robert Frank
COMPLAINT CONTROL NUMBER: 21-AS-20260414140012
FACILITY NAME:CARING HANDS AT CLOVERDALEFACILITY NUMBER:
496804294
ADMINISTRATOR:SIMS, KAREN P.FACILITY TYPE:
740
ADDRESS:214 W. 3RD STREETTELEPHONE:
(707) 894-3119
CITY:CLOVERDALESTATE: CAZIP CODE:
95425
CAPACITY:6CENSUS: 2DATE:
07/09/2026
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Karen Sims, AdministratorTIME COMPLETED:
09:50 AM
ALLEGATION(S):
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Facility is having financial issues
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Robert Frank arrived unannounced to deliver findings regarding the above allegation and met with facility Administrator Karen Sims.

During the course of the investigation LPA conducted a facility visit, conducted interviews, collected and reviewed documents.

Complaint alleges that the facility is having financial issues. A witness stated that the facility has not made payments on a promissory note signed by the licensees. A witness provided the promissory note in question. On 1/16/2026 a Judgement was entered against the facility for the amount of $8,131.54 in the Superior Court of California, County of Sonoma. LPA was provided with the Judgment and Notice of Entry of Judgment Documents. As of 7/7/2026 the Judgment amount has not been paid to the plaintiff.

Continued on 9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
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 3
Control Number 21-AS-20260414140012
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: CARING HANDS AT CLOVERDALE
FACILITY NUMBER: 496804294
VISIT DATE: 07/09/2026
NARRATIVE
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...Continued from 9099

Based on LPA’s interviews and record review, 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, are being cited on the attached 9099D.

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Exit interview conducted. Copy of report, LIC-9099, LIC-9099C, LIC-809D, Plan of Corrections and Appeal Rights discussed and provided to Administrator Sims. Signature on form confirms receipt of documents.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 21-AS-20260414140012
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: CARING HANDS AT CLOVERDALE
FACILITY NUMBER: 496804294
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/30/2026
Section Cited
CCR
87213
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87213 Finances The licensee shall have a financial plan..., Application for License, and that assures sufficient resources...for care of residents;... and shall submit such financial reports as may be required upon the written request of the licensing agency. This requirement is not met as evidenced by:
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Licensee will pay the full Court ordered judgement in the amount of $8131.54 and provide proof of payment to Community Care Licensing by POC due date of 7/30/2026.
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Based on interview & record review, the licensee did not comply with the section cited above in the facility has not paid a court ordered judgement which poses a potential health, safety or personal rights risk to persons 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: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3