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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 216803008
Report Date: 11/19/2025
Date Signed: 11/19/2025 02:36:31 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
09/23/2025 and conducted by Evaluator Caitlynn Felias
COMPLAINT CONTROL NUMBER: 21-AS-20250923154348
FACILITY NAME:TERRA LINDA CHRISTIAN HOMES, INC # 5FACILITY NUMBER:
216803008
ADMINISTRATOR:BRIAN BAUTISTAFACILITY TYPE:
740
ADDRESS:631 BAMBOO TERRACETELEPHONE:
(415) 479-3556
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY:6CENSUS: 6DATE:
11/19/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Staff Members, Elena Mendoza and Ana Renderos, Administrator, Bella Nachor, and Licensee, Ana BautistaTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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9
Staff did not get timely medical care for resident
INVESTIGATION FINDINGS:
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5
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9
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11
12
13
At approximately 9:15AM, Licensing Program Analyst (LPA) Felias arrived unannounced to continue a Complaint Investigation regarding the above allegation and met with Staff Members, Elena Mendoza and Ana Renderos. Licensee, Ana Bautista, and Administrator, Bella Nachor, arrived during visit at approximately 9:55AM. Licensee left facility at approximately 11:40AM.

During the course of the investigation, the Department requested and reviewed documents, conducted interviews, and made observations. The Department investigated the following allegations, “Staff did not get timely medical care for resident.” Complaint alleged that Resident 1 (R1) had a fall and sustained bruising to their face, back, and bottom. Complaint also stated that R1 was on hospice and facility should have contacted 911 because R1 was “black and blue.”

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

DATE: 11/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025
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 4
Control Number 21-AS-20250923154348
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: TERRA LINDA CHRISTIAN HOMES, INC # 5
FACILITY NUMBER: 216803008
VISIT DATE: 11/19/2025
NARRATIVE
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Continued from LIC9099

Incident Report for R1 received on 05/30/2024 stated that R1 had an unwitnessed fall on 05/27/2024 and sustained a small cut to their eyebrow. Report further stated facility notified R1’s responsible party and contacted Hospice for further instructions. Based on staff interviews conducted, facility staff applied first aid and contacted the hospice nurse. Per staff interviews, the nurse conducted a telephone assessment and determined that R1 did not have a head injury since R1 was able to respond appropriately. Per facility documents, R1’s hospice agency visited on 05/28/2025 for a follow-up. Review of hospice documents indicated that R1 denied hitting their head and denied having post-fall pain.

Based on record review, interviews conducted, and observations made, this allegation is Unsubstantiated. A finding that a 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 Administrator. Signature on form confirms receipt of documents.

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

DATE: 11/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 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
09/23/2025 and conducted by Evaluator Caitlynn Felias
COMPLAINT CONTROL NUMBER: 21-AS-20250923154348

FACILITY NAME:TERRA LINDA CHRISTIAN HOMES, INC # 5FACILITY NUMBER:
216803008
ADMINISTRATOR:BRIAN BAUTISTAFACILITY TYPE:
740
ADDRESS:631 BAMBOO TERRACETELEPHONE:
(415) 479-3556
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY:6CENSUS: 6DATE:
11/19/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Staff Members, Elena Mendoza and Ana Renderos, Administrator, Bella Nachor, and Licensee, Ana BautistaTIME COMPLETED:
02:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not notify authorized representative of injury timely
Medication Errors
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At approximately 9:15AM, Licensing Program Analyst (LPA) Felias arrived unannounced to continue a Complaint Investigation regarding the above allegation and met with Staff Members, Elena Mendoza and Ana Renderos. Licensee, Ana Bautista, and Administrator, Bella Nachor, arrived during visit at approximately 9:55AM. Licensee left facility at approximately 11:40AM.

During the course of the investigation, the Department requested and reviewed documents, conducted interviews, and made observations. The Department investigated the following allegations, “Staff did not notify authorized representative of injury timely, and Medication Errors.” Complaint alleged that R1’s responsible party wasn’t contacted about R1’s fall until the afternoon of the same day. Complaint also stated that when R1’s responsible party was visiting the facility, they observed the bruising on R1’s back and bottom and found pills in a crumpled napkin and in R1’s clothes pocket.

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

DATE: 11/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 21-AS-20250923154348
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: TERRA LINDA CHRISTIAN HOMES, INC # 5
FACILITY NUMBER: 216803008
VISIT DATE: 11/19/2025
NARRATIVE
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Continued from LIC9099A

LPA conducted interview with R1’s Responsible Party. Per Responsible Party, they have had no concerns regarding R1’s care at the facility. They have never observed R1 to be bruised or “black and blue,” on their back, bottom, or face. Responsible Party stated that they have seen sores or bruises on R1 before but they have always been aware of where the injuries came from. Responsible Party further stated that the facility provides them with a report about R1 every day and that they have never found or observed loose pills at the facility or pills in R1’s pockets. Responsible Party stated that the information being investigated is false and could not be true.

Based on record review, interviews conducted, and observations made, these allegations 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 Administrator. Signature on form confirms receipt of documents.

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

DATE: 11/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4