126803254-4-14-2026-21-AS-KMOA-DTDVPD-20260422163632

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 126803254
Report Date: 04/14/2026
Date Signed: 04/14/2026 12:55:58 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
09/05/2025 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20250905092410

FACILITY NAME:	ADDIE MEEDOM HOUSE		FACILITY NUMBER:	126803254
ADMINISTRATOR:	MACHELLEE ALLISON		FACILITY TYPE:	740
ADDRESS:	1445 PARKWAY DRIVE		TELEPHONE:	(707) 464-3311
CITY:	CRESCENT CITY	STATE: CA	ZIP CODE:	95531
CAPACITY:	63	CENSUS: 25	DATE:	04/14/2026
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Machellee Allison		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Neglect/Lack of supervision resulted in resident being sexually assaulted

Staff did not prevent a resident from engaging in inappropriate sexual behavior in a common area

INVESTIGATION FINDINGS:

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At approximately 9:15AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to deliver findings from an investigation conducted by the Department into the above allegations. LPA met with Executive Director Machellee Allison.
Neglect/Lack of supervision resulted in resident being sexually assaulted: Based on interviews conducted and a review of records indicate that resident, R1, was transferred from Memory Care to Assisted Living within a week of admission, resulting in a reduced level of supervision. R1’s care plan required that R1’s location be known at all times, due to exit seeking behaviors. Interviews conducted with staff, indicate that R1 should not have been moved out of Memory Care if such behaviors were present and staff were unable to explain the rationale for the downgrade in R1’s care. On 9/1/2025, staff observed R1 in Resident's (R2) room and reported the abnormal behavior to management; no immediate risk indicators were identified at that time. Statements confirm that on 9/3/2025, after staff observed R2’s door being closed, which is not common for R2 which is left open for staff to check on R2 every 30 minutes or so for safety checks. On 9/3/25, staff entered R2’s room and witnessed R1 sexually assaulting R2. Staff promptly intervened, contacted emergency medical services and law enforcement. Continued on LIC9099-C...

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026

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 4

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
09/05/2025 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20250905092410

FACILITY NAME:	ADDIE MEEDOM HOUSE		FACILITY NUMBER:	126803254
ADMINISTRATOR:	MACHELLEE ALLISON		FACILITY TYPE:	740
ADDRESS:	1445 PARKWAY DRIVE		TELEPHONE:	(707) 464-3311
CITY:	CRESCENT CITY	STATE: CA	ZIP CODE:	95531
CAPACITY:	63	CENSUS: 25	DATE:	04/14/2026
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Machellee Allison		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Facility failed to conduct an adequate pre-admission appraisal.

INVESTIGATION FINDINGS:

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At approximately 9:15AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to deliver findings from an investigation conducted by the Department into the above allegation. LPA met with Executive Director Machellee Allison.
Based on interviews conducted and records reviewed, the facility conducted an initial assessment on 08/09/2025 which showed prior acts of aggression and exit seeking behaviors. This document shows facility was informed of R1’s behaviors upon admission to the facility.
The facility conducted the pre-admission appraisal for R3 on 06/27/2025 which showed R3 was known to have dementia and sexually inappropriate behaviors. Based on records reviewed, R3 was a temporary placement awaiting placement in a higher level of care. There is sufficient evidence to show the facility did conduct an adequate pre-admission appraisal for both R1 and R3.

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.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026

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-20250905092410

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: ADDIE MEEDOM HOUSE	FACILITY NUMBER: 126803254
	VISIT DATE: 04/14/2026

NARRATIVE

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Interviews revealed that over two hours had passed without staff awareness of R1s’ whereabouts prior to the incident. Based on the above information there is sufficient evidence to conclude that staff failed to provide the level of supervision required to prevent the incident. Based on records reviewed and interviews conducted, the facility failed to provide safety and adequate supervision to R2 that resulted in R2 being sexually assaulted.

Staff did not prevent a resident from engaging in inappropriate sexual behavior in a common area:

Based on interviews conducted and a review of records confirm that Resident, R3, did not require one-to-one supervision and was permitted to access communal areas. R3’s physician’s report documented a history of sexual behaviors and R3 exhibited sexually inappropriate behaviors upon admission to the facility. Staff redirected R3’s sexually inappropriate behavior in accordance with his care plan, regularly notified external providers, and initiated the process that led to their transfer to a specialized Memory Care Facility on 11/4/2025. However, interviews indicate that R3’s sexually inappropriate behaviors occurred significantly more frequently than documented and created a safety risk to other residents. R3 was reported to have been aggressive towards staff and did not respond to redirection. Facility did not increase R3’s level of supervision or modify their care plan to mitigate this risk. There is sufficient evidence to substantiate that staff failed to provide adequate supervision to prevent R3 from engaging in inappropriate sexual behaviors in communal areas.

Based on the Departments investigation, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED.
An immediate civil penalty is being assessed today in the amount of $500 for a violation that resulted in the sickness or injury of a resident in care.

The licensee was informed that an additional civil penalty might be assessed based on Health and Safety Code 1569.49(f), or 1548(e) or (f), 1568.0822(f)

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
This report was reviewed with Machellee Allison and Appeal rights were given.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 21-AS-20250905092410

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: ADDIE MEEDOM HOUSE	FACILITY NUMBER: 126803254
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/14/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/15/2026 Section Cited CCR 87461(a)(5)	1 2 3 4 5 6 7	87461 Mental Condition:(a) The facility shall determine the amount of supervision necessary by assessing the mental status of the prospective resident to determine if the individual:(5)has a documented history of behaviors which may result in harm to self or others. This requirement is not met as	1 2 3 4 5 6 7	Licensee agrees to submit a written plan describing how the facility will ensure residents needs are met and the proper supervision is provided. Plan should address the re-appraisal process for changes in condition including inappropriate interactions with residents and staff. Written plan shall be
	8 9 10 11 12 13 14	evidenced by: Based on records reviewed, Licensee did not ensure the necessary supervision was given, resulting in resident being sexually assaulted. This poses an Immediate Health, Safety or Personal rights risk to persons in care.	8 9 10 11 12 13 14	submitted to CCL by 04/15/2026.
Type A 04/15/2026 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411 Personnel Requirements – General:(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by: Based on records reviewed and interviews conducted, Licensee did not	1 2 3 4 5 6 7	Licensee agrees to submit a written plan describing how the facility will ensure residents needs are met and the proper supervision is provided. Plan should address the re-appraisal process for changes in condition including inappropriate interactions with residents and staff. Written plan shall be
	8 9 10 11 12 13 14	ensure staff were suffiencent in number to meet residents needs and to prevent sexually inappropriate behaviors. This poses an Immediate Health, Safety or Personal Rights risk to persons in care.	8 9 10 11 12 13 14	submitted to CCL by 04/15/2026.

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: Kimberley Mota
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026

LIC9099 (FAS) - (06/04)

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