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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 216804066
Report Date: 11/18/2025
Date Signed: 11/18/2025 03:38:44 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
09/09/2025 and conducted by Evaluator Anthony Loera
COMPLAINT CONTROL NUMBER: 21-AS-20250909154224
FACILITY NAME:BLUFFS AT HAMILTON HILL, THEFACILITY NUMBER:
216804066
ADMINISTRATOR:LOMELI. LISA MFACILITY TYPE:
740
ADDRESS:1 HAMILTON HILL DRIVETELEPHONE:
(415) 889-8026
CITY:NOVATOSTATE: CAZIP CODE:
94949
CAPACITY:95CENSUS: 82DATE:
11/18/2025
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Executive Director, Jose AcumabigTIME COMPLETED:
03:55 PM
ALLEGATION(S):
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Licensee does not ensure the facility has enough staff to meet the residents needs
INVESTIGATION FINDINGS:
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On 11/18/2025, Licensing Program Analyst (LPA) Loera conducted an unannounced visit for the purpose of delivering complaint findings. LPA arrived and met with Executive Director, Jose Acumabig. During the course of the investigation, LPA reviewed records, conducted interviews, and made observations.

Compliant alleges, licensee does not ensure the facility has enough staff to meet resident needs.

Based upon department record review, information provided was contradicting with a lack of corroborating evidence to support the allegation. It was alleged that licensee does not ensure the facility has enough staff to meet resident needs. Review of facilities Personnel Report (LIC500) shows 35 caregivers and 8 medication technicians. Staff schedules for the months of September and October show for Memory Care there are at least two medication technicians and six caregivers for AM shift (6:30am - 3:00pm), one medication technician and 5 - 6 caregivers for PM shift (2:30pm - 11:00 pm), and one medication technician and 2 - 3 caregivers for NOC shift (10:00 pm - 7:00 am).

continued on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Anthony Loera
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025
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 2
Control Number 21-AS-20250909154224
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: BLUFFS AT HAMILTON HILL, THE
FACILITY NUMBER: 216804066
VISIT DATE: 11/18/2025
NARRATIVE
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For Assisted Living staff schedules for the months of September, October and through the end of November show one medication technician and three caregivers scheduled for AM shift, PM shift shows one medication technician and 2-3 caregivers, and NOC shift shows one medication technician and 1-2 caregivers.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Anthony Loera
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2