496804373-4-3-2026-21-AS-VBEI-DT8NQ8-20260417103929

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496804373
Report Date: 04/03/2026
Date Signed: 04/03/2026 11:58:48 AM

Unsubstantiated

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
02/09/2026 and conducted by Evaluator Christi Coppo

COMPLAINT CONTROL NUMBER: 21-AS-20260209102652

FACILITY NAME:	AROHA MEMORY CARE		FACILITY NUMBER:	496804373
ADMINISTRATOR:	KALRA, RAJESH		FACILITY TYPE:	740
ADDRESS:	6575 OAKMONT DR		TELEPHONE:	(925) 683-1975
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95409
CAPACITY:	27	CENSUS: 7	DATE:	04/03/2026
		UNANNOUNCED	TIME BEGAN:	09:09 AM
MET WITH:	Joe Hansen, Executive Director		TIME COMPLETED:	12:13 PM

ALLEGATION(S):

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Staff did not administer medication to a resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christi Coppo arrived at this facility unannounced, to deliver findings for the above allegation. LPA met with Executive Director Joe Hansen. Licensee was available by phone.

Complaint alleges staff did not administer medication to a resident in care. Complainant states that a resident (R1), is on hospice but is not receiving their pain medication as necessary. Complainant reported that the licensee is not leaving the keys for the med cart and the staff are unable to access the medications to administer to the resident.

During investigation, LPA interviewed licensee. Per licensee, he had a conversation with R1 focused on explaining that they have two PRN pain medication options available. We reviewed the purpose of each medication, along with the risks and benefits, in an understandable way, so R1 could make an informed

Continued on 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026

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-20260209102652

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: AROHA MEMORY CARE	FACILITY NUMBER: 496804373
	VISIT DATE: 04/03/2026

NARRATIVE

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choice when requesting pain relief. When R1 reports pain, the staff process is as follows:
· Staff assess and acknowledge R1’s report of pain.

· Staff review the PRN medications that are currently ordered and available to R1.

· Staff ask R1 which medication they would prefer.

· Staff administer the medication R1 chooses according to physician orders and document the administration and response on a PRN MAR.

During investigation, LPA reviewed PRN MAR and Authorization letter for R1. PRN MAR incomplete as dates present for February but nothing for January. Resident moved in January 2026. Per licensee, the lack of MAR entries were due to the fact that facility was on boarding their e-MAR system ALICE, which also has other functionalities such as appraisals. However, LPA reviewed R1’s PRN Authorization letter and found that their physician marked that R1 “can determine and clearly communicate his/her need for prescription and non-prescription medication on a PRN basis. Therefore, there a PRN MAR was not required for R1.

During investigation, LPA conducted staff interviews. Two [2] out of three [3] staff denied not being able access to the medication cart. So, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted with Executive Director and copy of this report given.

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026

LIC9099 (FAS) - (06/04)

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