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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 216804066
Report Date: 12/30/2025
Date Signed: 12/30/2025 12:37:10 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
12/22/2025 and conducted by Evaluator Anthony Loera
COMPLAINT CONTROL NUMBER: 21-AS-20251222140731
FACILITY NAME:BLUFFS AT HAMILTON HILL, THEFACILITY NUMBER:
216804066
ADMINISTRATOR:RIVERA, MELONFACILITY TYPE:
740
ADDRESS:1 HAMILTON HILL DRIVETELEPHONE:
(415) 889-8026
CITY:NOVATOSTATE: CAZIP CODE:
94949
CAPACITY:95CENSUS: 81DATE:
12/30/2025
UNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Melon Rivera, Executive DirectorTIME COMPLETED:
12:50 PM
ALLEGATION(S):
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Staff are not able to answer call buttons in a timely manner
INVESTIGATION FINDINGS:
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On 12/30/2025, Licensing Program Analyst (LPA) Loera conducted an unannounced visit for the purpose of delivering complaint findings regarding the above allegation. LPA arrived and met with Executive Director, Melon Rivera. During the investigation, LPA reviewed documents and made observations.
Reporting Party (RP) stated on Friday 12/19/2025, resident (R1) had to wait over 2.5 hours for help to get out of bed. Document review of conversation show that a staff went to assist R1 within 12 minutes but left to grab another staff to assist and came back claiming no one was there to help and left again forgetting R1. Another staff member came to assist R1 at 6:46am. Document review of R1s alarm response report shows on 12/19/2025, R1 pressed their pendant at 3:55am and did not receive assistance out of bed until 6:46am, 2 hours and 50 minutes total. RP stated on Sunday morning 12/21/2025, resident (R2) pulled their room cord for assisance and didn't receive assistance. Document review of R2s alarm response report shows on the 12/21/2025 at 6:05am, R2 called for assistance and didn't receive help until 7:05am, a total of one hour.
Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Division 6, Chapter1 is being cited on the attached LIC 9099D. Appeal rights given. *civil penatly in the amount of $250 is being assessed for a repeat violation in a 12 month period*
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Anthony Loera
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
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-20251222140731
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/12/2026
Section Cited
HSC
1569.269(a)(6)
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ยง1569.269 Enumerated rights... (a)Residents...shall have all of the following rights:(6) To care, supervision, and services that meet their individual needs...delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs........
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Licensee shall conduct training for all care staff on how residents pendant calls will be responded to in a timely manner and shall submit proof of completed training for all staff to Community Care Licensing (CCL) by 01/12/2026.
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....This requirement was not met by licensee as evidenced by: Based on LPA record review of facility's pendant call button system log, R1s bell response time was 2 hours and 50 minutes and R2s bell response time was one hour, which poses a potentional risk to the health and safety of residents in care.
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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: Anthony Loera
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2