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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 570316115
Report Date: 04/29/2026
Date Signed: 04/29/2026 12:37:51 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
11/13/2025 and conducted by Evaluator Jill Nakagawa
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20251113112003
FACILITY NAME:CALIFORNIAN, THEFACILITY NUMBER:
570316115
ADMINISTRATOR:VALADEZ, FERNANDOFACILITY TYPE:
740
ADDRESS:1224 COTTONWOOD STREETTELEPHONE:
(530) 666-2433
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY:130CENSUS: 67DATE:
04/29/2026
ANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Fernando Valadez and Kathy Neeser AdministratorTIME COMPLETED:
12:35 PM
ALLEGATION(S):
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Staff does not seek medical attention for resident in a timely manner
Staff mismanages residents' medications.
Staff does not ensure incident reports are being reported.
Staff does not ensure facility operates in ratio.
INVESTIGATION FINDINGS:
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On 04/29/2026 Licensing Program Analyst (LPA) Nakagawa met with Administrators Fernando Valadez and Kathy Neeser in the Regional Office to complete the complaint investigation regarding the above allegations.

The complaint alleges that Staff does not seek medical attention for resident in a timely manner. The complainant believes that med techs are instructing care staff to pick up fallen residents from the floor, and med techs not evaluating said fallen residents; rather when residents are evaluated, emergency services such as EMS and Fire are not contacted for professional services. Based on the review of incident reports and staff interviews, LPA found that it is well-understood by staff and med techs that it isrequired by facility to call 911 for any unwitnessed fall, injury or other condition requiring an immediate medical assessment, therefore the allegation that Staff does not seek medical attention for resident in a timely manner is unsubstantiated.

Continued on 9099-C.....
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2026
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-20251113112003
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: 04/29/2026
NARRATIVE
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Continued from 9099....

The complaint alleges that “Staff does not ensure incident reports are being reported”. The complainant states that the Staff are not appropriately reporting incidents. Complainant states that staff (S1) is willingly reading and disposing of Incident Reports constructed by care staff. LPA reviewed incident reports submitted and found that through October and November of 2025 there were 7 incident reports submitted; 5 were death reports, 1 was a resident requiring medical treatment and 1 was for a fall. LPA spoke with 8 staff members: 8 of 8 staff members stated that they do not believe staff/med techs/Administrator are ignoring their reporting of incidents nor is the Administrator disposing of incident reports that staff are submitting. Based on the interviews conducted and review of Incident Reports submitted the allegation that staff does not ensure incident reports are being reported is unsubstantiated. Although the allegation may have occurred there is not a preponderance of evidence therefore the allegation is unsubstantiated.

The complaint alleges “Staff does not ensure facility operates in ratio”. The facility staff schedule shows coverage in Assisted Living, Memory Care and Hospice units. LPA also discussed staffing with Administrator who stated that call-offs are covered by Administrator and/or Directors to ensure adequate coverage. A review of staff schedules shows that there are 2 to 3 care staff and one med technician scheduled in memory care per shift, 1 care giver for the hospice wing per shift and 2 to 3 care staff for the Assisted Living with the med technician depending on the shift. This facility is licensed as a Residential Care Facility for the Elderly (RCFE) and Title 22 Regulations does not require any staffing ratio. Regulations for RCFE’s state that staff provides adequate care and supervision. The complainant stated that California Code of Regulations (22 CCR)§ 87865.1 (for residential care facilities for the chronically ill) requires ratios, however this facility is not a residential care facility for the chronically ill and therefore this regulation does not apply. The allegation that “Staff does not ensure facility operates in ratio” is unsubstantiated. Although the allegation may have occurred there is not a preponderance of evidence.

The Complaint alleges that “Staff mismanages residents' medications”. The complainant states that med techs are not properly utilizing hand over hand method when administering medications; as well as not administering medications in a timely manner." LPA conducted interviews with 4 med techs and asked them to explain the hand-over-hand technique. 4 of 4 med technicians were able to demonstrate the correct method. LPA also asked them to explain what they would do if the resident was unable to participate in the hand over hand method and 4 of 4 responded that they would call hospice to administer the medications because they are only allowed to assist. The complainant also stated that medications were not administered in a timely manner. A review of the Medication Administration Records (MARs) indicate that medications were administered as per doctors’ orders. Based on interviews with staff and review of medication administration records the allegation that “Staff mismanaged residents’ medications” is unsubstantiated. Although the allegation may have occurred there is not a preponderance of evidence therefore the allegation is unsubstantiated.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2