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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496830784
Report Date: 03/16/2026
Date Signed: 03/16/2026 02:58:43 PM

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
03/13/2026 and conducted by Evaluator Dina Alviso
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20260313091722

FACILITY NAME:AMANI DAY SERVICESFACILITY NUMBER:
496830784
ADMINISTRATOR:CATIIS, REGINALD ROSSFACILITY TYPE:
775
ADDRESS:5420 STATE FARM DR SUITE ATELEPHONE:
(707) 791-3290
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY:30CENSUS: DATE:
03/16/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Vonstarsi Bernil & Supervisor Erica De VeraTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff did not follow proper reporting requirements
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alviso arrived to conduct a complaint inspection, and met with new Administrator Vonstarsi Bernil, and Supervisor Erica De Vera, on 3/16/26 at approximately 9:30am. Administrator was the facility's former Activity Director.

Reporting party alleges that "facility staff did not follow proper reporting requirements."

LPA requested client records, of C1, and facility program records. LPA reviewed records and requested specific copies of documents. Administration staff provided requested copies to the LPA during the inspection

Investigation revealed that facility staff received information on 2/19/26, by phone, regarding an incident of suspected abuse of a client (C1) at the day program. The facility staff did not submit an LIC624 incident report to the Department within regulation time frame, as required; Licensee/Administrator submitted an incident report on 3/9/26.

Continued on LIC9099C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 21-AS-20260313091722
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: AMANI DAY SERVICES
FACILITY NUMBER: 496830784
VISIT DATE: 03/16/2026
NARRATIVE
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 The facility staff did not complete and submit an SOC341, suspected elder/adult abuse report as required by staff, as mandated reporters. There was sufficient information obtained to support the alleged violation occurred.

Per investigation, incident reported was reported to S1, facility staff, on 2/19/26, and the facility did not report to the Licensing agency until 3/9/26; Licensing Agency did not receive an SOC341 Suspected Elder/Adult Abuse report as required by law. Deficiency cited: W&I 15630(b)(1) Elderly and Dependent Adult Abuse Mandated Reporting Requirement.

Deficiency cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.

Exit interview conducted with Supervisor Erica De Vera Appeal Rights provided with complaint report, LIC9099s.

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 21-AS-20260313091722
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: AMANI DAY SERVICES
FACILITY NUMBER: 496830784
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/16/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/30/2026
Section Cited
CCR
15630(b)(1)
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W&I 15630(b)(1) Elderly and Dependent Adult Abuse Mandated Reporting Requirements. Any mandated reporter who, in his or her professional capacity, or within the scope of his or her employment, has observed or has knowledge of an incident that reasonably appears to be physical abuse, shall report the known or suspected instance of abuse by telephone or through a confidential Internet reporting tool,A written report shall be sent within two working days.
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Licensee to have a"Regional Staff" member hold an in-service training with all staff regarding "Suspected Elder/Adult Abuse" and "Reporting Requirements" with administration staff, to ensure all incidents are reported as required.
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Facility staff, failed to report the incident of suspected eledr/adult abuse reported on C1. The Department never received the SOC341 or the LIC624 Incident report. This is a risk to clients personal rights.
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Submit proof of training held with all staff, and proof of additional training held with administration staff. Plan of future compliance and proof of trainings due by 3/30/26.
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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: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4