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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496804324
Report Date: 05/08/2026
Date Signed: 05/08/2026 09:26:18 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
04/09/2026 and conducted by Evaluator Marisol Cuadra
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20260409145519
FACILITY NAME:RESERVE AT FOUNTAINGROVE MEMORY CARE, THEFACILITY NUMBER:
496804324
ADMINISTRATOR:ORDING, KELLYFACILITY TYPE:
740
ADDRESS:200 FOUNTAINGROVE PKWYTELEPHONE:
(707) 544-4909
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY:64CENSUS: 25DATE:
05/08/2026
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Kelly Ording (Administrator)TIME COMPLETED:
09:45 AM
ALLEGATION(S):
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-Facility does not have adequate staff to meet residents care needs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a complaint investigation and delivered findings regarding the allegation listed above and met with Administrator, Kelly Ording.

The Department received an allegation of facility does not have adequate staff to meet residents’ care needs. According to the reporting party, since beginning of March 2026 there have only been two caregivers and one medication technician working all three shifts (AM, PM, NOC) with approximately 25 residents of which approx. six are two people assists. The reporting party explains that one staff member is required to perform activities of daily living (ADL) including serving all meals, incontinence care and laundry for 16 residents, where staff have to split between “assisted care and memory care”. Furthermore, it appears like staff and resident’s responsible parties have been verbally requesting additional staffing from management, but their response has only indicated they are looking for how to fill job positions.
Continue on LIC9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026
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 2
Control Number 21-AS-20260409145519
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: RESERVE AT FOUNTAINGROVE MEMORY CARE, THE
FACILITY NUMBER: 496804324
VISIT DATE: 05/08/2026
NARRATIVE
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Continue on LIC9099...
During the course of this investigation, LPA conducted 10-day visit, made observations, reviewed records, interviews with staff and residents in care. During LPA’s visit, LPA conducted a tour of the facility and observed three caregivers and one med-tech. Based on records review, LPA was provided with LIC 500 personnel report and staff schedules for Memory Care Unit for the months of March and April 2026 with a census of 27 residents in care which are divided into three groups with an average of six residents per group. Per staff schedules indicate that the facility had an average of one assigned caregiver on duty for a group of six residents in care and one med-technician who alternates covering the floor when they are not passing medications Also, there was additional staffing including cooker, server and housekeeping personnel, but they do not provide caregiving assistance to residents in care. Furthermore, the alarm response report dated March 01, 2026, 12:00am through April 14, 2026, 9:30am did not provide any supportive evidence regarding delays in staff response times to assist residents in care. According to administrator most of the residents are not aware of the call alert system due to cognitive challenges and it was clarified that current residents are residing at the memory care unit, but it was disclosed that the building is divided into two wings (East and West), where residents are located depending on their current care needs. Based on interviews conducted with residents (R1 & R2) and staff (S1, S2, S3, S4, S5 & S6) revealed conflicting information, resulting in LPA was unable to find any supporting evidence due to the very limited information obtained from interviews with residents and staff who indicated they could benefit by having additional staffing, because at times it gets busy between both wings, and they are suggesting to management to perform a better assessment of current residents’ care needs based on risk of elopement and behaviors, because there are more residents that have not been identified as needing two people assistance to manage their behaviors safely. However, staff recognized that the use of surveillance cameras in common areas that are monitored by the receptionist is helping to reduce elopement incidents. A finding that the complaint allegation occurs of facility does not have adequate staff to meet residents’ care needs 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, therefore the allegation is UNSUBSTANTIATED.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026
LIC9099 (FAS) - (06/04)
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