570316115-5-22-2025-21-AS-KMOA-DHDRSQ-20250606131708

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 570316115
Report Date: 05/22/2025
Date Signed: 05/22/2025 04:52:27 PM

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
01/22/2025 and conducted by Evaluator Jill Nakagawa

COMPLAINT CONTROL NUMBER: 21-AS-20250122122628

FACILITY NAME:	CALIFORNIAN, THE		FACILITY NUMBER:	570316115
ADMINISTRATOR:	VALADEZ, FERNANDO		FACILITY TYPE:	740
ADDRESS:	1224 COTTONWOOD STREET		TELEPHONE:	(530) 666-2433
CITY:	WOODLAND	STATE: CA	ZIP CODE:	95695
CAPACITY:	130	CENSUS: 86	DATE:	05/22/2025
		UNANNOUNCED	TIME BEGAN:	03:45 PM
MET WITH:	Fernando Valadez, Administrator		TIME COMPLETED:	03:46 PM

ALLEGATION(S):

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Staff did not abide to the admission agreement
Staff is overcharging for services not received
Staff mishandled a resident's medication
Staff did not provide adequate care and supervision to the residents
Staff did not provide healthful and comfortable accommodations for a resident
Staff did not safeguard a resident's personal belongings
Staff did not ensure a resident attended scheduled appointments
Staff did not ensure a resident received therapy while in care

INVESTIGATION FINDINGS:

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On 5/22/2025 Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to continue the complaint investigation and to deliver findings regarding the above allegations. LPA Nakagawa met with Administrator Fernando Valadez. LPA toured the facility, reviewed resident records, made observations, interviewed staff and outside parties during the course of the investigation.
The complaint alleges that the Staff did not abide by the admission agreement; stating that resident (R1) moved out of the facility on 9/30/2024, but continued to be billed for monthly rent and cable for October 2024. Based on a review of resident R1’s admissions agreement signed by R1’s responsible party, states a 30-day notice must be given prior to move-out. Records indicate R1 vacated the facility on 9/30/2024 but a 30-day notice was not given to the facility, therefore the allegation that the staff did not abide by the admission agreement is unsubstantiated.
Continued on 9099-C.....

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025

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-20250122122628

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: CALIFORNIAN, THE	FACILITY NUMBER: 570316115
	VISIT DATE: 05/22/2025

NARRATIVE

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Continued from 9099.....
The complaint alleges that Staff is overcharging for services not received. Based on review of R1’s admissions agreement, services are all inclusive; there is no breakdown in charges for particular services therefore the allegation that Staff is overcharging for services not received is unsubstantiated.

The complaint alleges that Staff did not ensure a resident attended scheduled appointment; stating that the facility did not take R1 to scheduled appointments on 9/4/24 and 9/20/24. The complainant stated that staff (S1) was told about the appointments. LPA interviewed S1 who stated that they were unaware of the appointments. LPA also audited the appointment system which runs through the Reception Desk. The system found two appointments listed for 9/19/24 and 10/02/24 (note says family is taking). Neither of the dates match those of the missed appointments. LPA was unable to corroborate the allegation therefore the allegation that Staff do not ensure resident attended scheduled appointments is unsubstantiated. As there is a lack of evidence to substantiate that Staff were aware of appointments, there is not enough corroborating evidence to support the allegation that Staff caused R1 not to receive therapy while in care. Although the allegations may have happened there is not a preponderance of evidence to substantiate the allegations therefore the allegations are unsubstantiated.

Continued on 9099-C.2

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 21-AS-20250122122628

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: CALIFORNIAN, THE	FACILITY NUMBER: 570316115
	VISIT DATE: 05/22/2025

NARRATIVE

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Continued from 9099-C
The complaint alleges that Staff did not provide adequate care and supervision to the residents; Staff did not provide healthful and comfortable accommodations for a resident; and, Staff did not safeguard a resident's personal belongings. LPA requested care notes for R1 during their time in Memory Care. LPA found no incident reports regarding R1. LPA found no indications that R1 was hurt and review of Inventory List which was signed by responsible party but no belongings were documented and there were no belongings reported as stolen. Therefore the allegations are unsubstantiated. Although the allegations may have happened there is not a preponderance of evidence to substantiate the allegations therefore the allegations are unsubstantiated.

Finally, the complaint alleges that Staff mishandled a resident's medication; stating that a medication technician gave R1 the wrong medication and reported the error to doctor. Records of dispensed medications were reviewed and no error was found. Interviews were conducted but unable to corroborate the allegation. Although the allegation may have happened there is not a preponderance of evidence to substantiate the allegation therefore the allegation is unsubstantiated.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 3