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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 216801028
Report Date: 02/27/2026
Date Signed: 02/27/2026 04:21:14 PM

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
10/24/2025 and conducted by Evaluator Caitlynn Felias
COMPLAINT CONTROL NUMBER: 21-AS-20251024233242
FACILITY NAME:DRAKE TERRACEFACILITY NUMBER:
216801028
ADMINISTRATOR:ARLENE SAMONTEFACILITY TYPE:
740
ADDRESS:275 LOS RANCHITOS ROADTELEPHONE:
(415) 491-1935
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY:130CENSUS: 134DATE:
02/27/2026
UNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Resident Care Coordinator, Ivon Vargas, and Care Services Director, Tess EstiloTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Facility charged a resident for services not rendered
Did not meet resident care needs
Facility did not seek timely medical
Reporting requirements
Not responding to resident call pendants
INVESTIGATION FINDINGS:
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At approximately 8:35AM, Licensing Program Analyst (LPA) Felias arrived unannounced to continue a complaint investigation regarding the above allegations and met with Resident Care Coordinator, Ivon Vargas. Care Services Director, Tess Estilo, arrived during visit at approximately 9AM.

During the course of the investigation, the Department requested and reviewed documents, conducted interviews, and made observations. The Department investigated the following allegations, "Facility charged a resident for services not rendered, Did not meet resident care needs, Facility did not seek timely medical, Reporting requirements, and Not responding to resident call pendants."

"Facility charged a resident for services not rendered" and "Did not meet resident care needs" - Complaint alleged that the facility overcharged R1 for services that were not contracted on or received. Per complaint, R1 moved to the facility in 2024, and were assessed at a Level 5 for care at $7,645/month. R1 was then
Continued on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2026
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 6
Control Number 21-AS-20251024233242
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: DRAKE TERRACE
FACILITY NUMBER: 216801028
VISIT DATE: 02/27/2026
NARRATIVE
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Continued from LIC9099

still at a Level 5 but the cost of care was $4,785/month. Per complaint, R1 is now at Level 4 for care and is being charged $3,700/month. However, facility charged R1 $4,400 for care when R1 should have been charged $3,700.

Review of R1's documents showed that R1 moved to the facility on 09/27/2024. R1's initial care plan dated 10/02/2024, was documented to be $4,830.00/month. R1 was reassessed on 11/03/2024. This care plan was shown to be signed by the facility and responsible party on 11/05/2024 and was for $3,700/month. Review of R1's file showed that R1 had an assessment for "Level Assisted Living Custom" on 11/03/2024 with an effective date of 11/05/2024 at $4,410/month. Per Care Services Director (CSD), this assessment occurred due to the system update that happened with the facility's assessment care tool.

Per interview with CSD, residents are on a point based system. The discrepancy occurred because the facility updated their care assessment tool system which implemented additional points and new levels of care. It was identified that with the system update, the tool automatically reassessed R1 and allotted care points based on the new levels of care. This increased R1's total amount of points and increased the amount due per month.

Email correspondence provided to the Department showed that the facility notified R1's responsible party of the clerical error on 09/05/2025, stating that the facility identified that R1's care plan had increased. Per email, the facility credited R1 and their responsible party based on the original care plan that had been received. Review of R1's statement showed that the facility issued a rent credit for "care discrepancy for 11/2024 to 09/01/2025" in the amount of $7,810.00 which was applied to R1's overall statement balance.

Complaint also stated that R1 was not receiving services such as escorting or attending activities and only recently started attending activities in Fall 2025.

Review of R1's care plan dated 11/05/2024 and 9/22/2025, both stated that R1 required assistance with escorts and was to receive activity reminders. Interviews conducted with facility staff stated that R1 is escorted to meals and activities when they wanted to attend. 6 of 6 staff members stated that R1 is escorted to the dining room for only for lunch and dinner because they prefer not to eat breakfast. 6 of 6 staff members stated that R1 will attend activities that they like to do such as movie night, bingo, music, or exercise class but will refuse if it's an activity they do not like or don't want to participate in. Review of R1's Activities of Daily Living (ADL) log for 2024 and 2025 showed tasks such as escorting and reminders for activities as completed. It was observed that the 2025 log showed incomplete tasks from 02/21/2025 to 04/10/2025 because R1 was out of the community.

Based on record review, interviews conducted, and observations made, these allegations are Unsubstantiated.
Continued on LIC9099C
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 21-AS-20251024233242
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: DRAKE TERRACE
FACILITY NUMBER: 216801028
VISIT DATE: 02/27/2026
NARRATIVE
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Continued from LIC9099C

“Not seeking timely medical and Reporting Requirements” - Complaint alleged the following: facility did not inform R1's responsible party or primary care physician that R1 had lost 10 pounds, that facility did not seek medical care for R1 timely after they had a fall on 02/20/2025, and that facility did not report R1's fall to Community Care Licensing (CCL).

Interview conducted with CSD stated that the facility provides a service to take resident vitals and weights monthly. If it is observed that a resident had a weight fluctuation of plus or minus five pounds, then the facility would notify the resident’s primary care physician and responsible party. Per CSD, R1 was not in the community for a period of time as they were at a skilled nursing facility.

Review of R1’s facility weight log recorded R1’s weight in February 2025 as 141.2lbs. Review of R1’s care log notes indicated that R1 was out of the community from 02/20/2025 to 04/09/2025 and stated that R1 was expected to be discharged from a skilled nursing facility on 04/09/2025. Care log notes stated that R1 returned to the community on 04/10/2025. Review of R1’s physician’s report dated 04/06/2025 showed that their weight was 132.8lbs, and their skilled nursing facility discharge paperwork dated 04/10/2025 showed that their weight was 137.1lbs.

R1’s facility weight log showed that they refused to have their weight taken on 05/01/2025 but had their weight taken during a physician’s visit on 05/06/2025 which recorded their weight as 130lbs. On 06/19/2025, R1’s weight was recorded as 125.7lbs. Review of facility documents showed that facility contacted R1’s responsible party and primary care team on 06/19/2025 to inform them of the weight change. Per notes dated 06/23/2025, R1’s primary care team responded to facility staff stating that they discussed the weight loss with R1’s responsible party and sent physician orders to the facility on 06/20/2025. Review of R1’s documents showed that facility received physician orders for a Glucerna Shake to be consumed twice a day on 06/20/2025.

Complaint alleged that R1 did not receive timely medical care on 02/20/2025 and that R1's fall was not reported to Community Care Licensing. Per complaint, R1 had a fall around 4:00AM on 02/20/2025 and wasn’t sent to the hospital until 8:00AM on the same day. Complaint stated that R1 should have been sent to the hospital at 4:00AM and stated that 911 wasn't contacted until after R1's responsible party arrived to the facility after 8AM.

Interview conducted with Witness revealed that video surveillance footage showed that the ambulance was called after facility staff called R1's responsible party on 02/20/2025. Department was unable to review video surveillance footage to
confirm when the ambulance arrived as it was no longer available.
Continued on LIC9099C
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 21-AS-20251024233242
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: DRAKE TERRACE
FACILITY NUMBER: 216801028
VISIT DATE: 02/27/2026
NARRATIVE
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Continued from LIC9099C

Community Care Licensing (CCL) received an incident report for R1 on 02/27/2025. Review of R1's incident report stated that at approximately 07:40AM, R1 was observed to be weak, with tremors, and had profuse sweating. Paramedics were called and R1 was transported to the hospital, and R1's primary care physician and responsible party were notified. Review of email correspondence showed that the facility and responsible party communicated about R1's incident on 02/20/2025.
Per Title 22 Regulations, Reporting Requirements, 87211(a)(1)(D), an incident report should be submitted to CCL, for "Any incident which threatens the welfare, safety or health of any resident..."

Review of R1’s care log notes stated that on 02/20/2025, R1 was observed on the floor by facility staff at approximately 4:20AM. Per care log notes, R1 denied pain or discomfort at the time of the incident. R1's care log for 02/20/2025 further reported that R1 was sent to the emergency room after they were observed to be weak, shaking, and sweating later in the day. 4 of 6 staff interviews and interview conducted with CSD stated that R1 can communicate their needs and say if they are in pain or if something is wrong. Review of R1's Physician's Report dated 02/27/2025 stated that R1 is able to communicate their needs.

Based on record review, interviews conducted, and observations made, these allegations are Unsubstantiated.

"Not responding to resident call pendants." Complaint alleged that there have been instances of no response or lengthy responses when R1 presses their pendant. There was no additional information provided on when these instances occurred. Interviews conducted with facility staff revealed conflicting statements. 3 of 7 staff interviews stated that R1 has said they have waited for a long time to receive help but these interviews also stated that R1 says they have been waiting for a long time but hasn't. 4 of 7 staff interviews stated R1 has not reported long or lengthy response times. Interviews also revealed conflicting statements on what a facility staff member's response time should be. Per interviews, staff stated that pendant call times were to be responded to within 3-7 minutes, with the maximum time being 10 minutes. LPA was unable to pull pendant call records to review as they were unavailable.

Based on interviews conducted, this allegation is Unsubstantiated.

A finding that the complaint allegation is Unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

Exit interview conducted. Copy of report discussed and provided to Care Services Director. Signature on form confirms receipt of documents.

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 6
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
10/24/2025 and conducted by Evaluator Caitlynn Felias
COMPLAINT CONTROL NUMBER: 21-AS-20251024233242

FACILITY NAME:DRAKE TERRACEFACILITY NUMBER:
216801028
ADMINISTRATOR:ARLENE SAMONTEFACILITY TYPE:
740
ADDRESS:275 LOS RANCHITOS ROADTELEPHONE:
(415) 491-1935
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY:130CENSUS: 134DATE:
02/27/2026
UNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Resident Care Coordinator, Ivon Vargas, and Care Services Director, Tess EstiloTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Facility did not follow eviction procedures
INVESTIGATION FINDINGS:
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At approximately 8:35AM, Licensing Program Analyst (LPA) Felias arrived unannounced to continue a complaint investigation regarding the above allegations and met with Resident Care Coordinator, Ivon Vargas. Care Services Director, Tess Estilo, arrived during visit at approximately 9:00AM.

During the course of the investigation, the Department requested and reviewed documents, conducted interviews, and made observations. The Department investigated the following allegation, "Facility did not follow eviction procedures."

Complaint alleged that facility provided R1 with an eviction notice after it had been verbally agreed upon when R1 moveed into the facility that they would not have knowledge of their financial situation. Complaint reported that facility should not have provided R1 with their eviction notice as it caused unnecessary stress.

Continued on LIC9099C
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 21-AS-20251024233242
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: DRAKE TERRACE
FACILITY NUMBER: 216801028
VISIT DATE: 02/27/2026
NARRATIVE
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Continued from LIC9099

Review of facility records showed that the Santa Rosa Regional Office received an eviction notice for R1 on 10/21/2025 for non-payment of fees. Facility correspondence showed that on 11/04/2025, the facility rescinded their October 2025 eviction notice and re-issued an eviction notice to R1 and their responsible party on 11/21/2025 for non-payment of fees.

Per interview with Hospitality Services Director (HSD), an error was found in the amount that R1 owed in October 2025. An internal investigation was conducted by the corporation where it was found that R1 still had an overdue balance with non-payment of fees. Therefore, a secondary eviction notice for non-payment of fees was issued in November 2025. Per Title 22 Regulations, Eviction Procedures, 87224(a) and 87224(c): 87224(a) the licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5)...Thirty (30) days written notice to the resident is required…(1) Nonpayment of the rate for basic services..." and 87224(c) The licensee shall, in addition to either serving the required thirty (30) days notice…on the resident, notify or mail a copy of the notice to quit to the resident's responsible person.”

Based on record review, interviews conducted, and observations made, this allegation is Unfounded. An allegation that is Unfounded means that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview conducted. Copy of report discussed and provided to Care Services Director. Signature on form confirms receipt of documents.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 6