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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 216804183
Report Date: 11/20/2025
Date Signed: 11/20/2025 01:40:55 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
10/13/2025 and conducted by Evaluator Shannan Hansen
COMPLAINT CONTROL NUMBER: 21-AS-20251013161836
FACILITY NAME:MEADOW CREEK SENIOR LIVINGFACILITY NUMBER:
216804183
ADMINISTRATOR:MUELRATH, KELLYFACILITY TYPE:
740
ADDRESS:40 MEADOW WAYTELEPHONE:
(707) 799-1557
CITY:SAN GERONIMOSTATE: CAZIP CODE:
94963
CAPACITY:6CENSUS: 6DATE:
11/20/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Kelly Muelrath, Licensee/AdministratorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Uncleared staff member providing care and supervision to residents in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Shannan Hansen was at facility conducting annual inspection and delivered complaint investigation findings regarding the above allegation. LPA met with Licensee/Administrator Kelly Muelrath.

During investigation LPA made 2 visits (10/16/25 &11/20/25), conducted 8 interviews with staff and outside parties, made observations and reviewed records.

Uncleared staff member providing care and supervision to residents in care- Complainant alleges there is a staff member working at the facility without background clearance. Background clearance record review of I1 revealed they were not cleared to work at a facility. Interview with Administrator on 10/16/2025 confirmed individual (I1) had been working at facility since August 2025 while working on getting background clearance.
Continue on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Shannan Hansen
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
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 5
Control Number 21-AS-20251013161836
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: MEADOW CREEK SENIOR LIVING
FACILITY NUMBER: 216804183
VISIT DATE: 11/20/2025
NARRATIVE
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Continued from LIC9099

Follow up interview with licensee revealed I1 ceased working 10/16/2025 and obtained different employment. There was sufficient information obtained that supported a violation had occurred.

Based on interviews and record/document reviews obtained during the investigation the allegation Uncleared staff member providing care and supervision to residents in care is Substantiated, meaning the preponderance of evidence standard has been met, therefore the above allegation is Substantiated.


**$500.00 civil penalty assessed for uncleared adult I1 working in facility

The following deficiencies were observed (see LIC 9099D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided.

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Shannan Hansen
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 21-AS-20251013161836
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: MEADOW CREEK SENIOR LIVING
FACILITY NUMBER: 216804183
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/21/2025
Section Cited
CCR
87355(e)(2)
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87355 Criminal Record Clearance (e)All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility (2) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement is not met as evidence by:
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Licensee/Administrator to submit self-certification of understanding of regulation. 87355(e)(1) & 87355(e)(2), and submit to CCL by POC due date 11/21/2025 to clear citation.
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Based on LPA record review from DOJ and interview with Licensee I1 was not background cleared prior to working at facility as required. LPA confirmed start date 8/2025. This is an immediate risk to the Health & Safety of residents in care.
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***Civil Penalties assessed in the amount of $500.
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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: Bethany Moellers
LICENSING EVALUATOR NAME: Shannan Hansen
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
10/13/2025 and conducted by Evaluator Shannan Hansen
COMPLAINT CONTROL NUMBER: 21-AS-20251013161836

FACILITY NAME:MEADOW CREEK SENIOR LIVINGFACILITY NUMBER:
216804183
ADMINISTRATOR:MUELRATH, KELLYFACILITY TYPE:
740
ADDRESS:40 MEADOW WAYTELEPHONE:
(707) 799-1557
CITY:SAN GERONIMOSTATE: CAZIP CODE:
94963
CAPACITY:6CENSUS: 6DATE:
11/20/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Kelly Muelrath, Licensee/AdministratorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Personal Rights
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Shannan Hansen was at facility conducting annual inspection and delivered complaint investigation findings regarding the above allegations. LPA met with Licensee/Administrator Kelly Muelrath.

During investigation LPA made 2 visits (10/16/25 & 11/20/25), conducted 8 interviews with staff and outside parties, made observations and reviewed records.

Personal Rights- Complainant alleges staff (S1) speaks inappropriately and aggressively to residents in care specifically resident (R1) and treats the elders in the home badly.
LPA conducted visits on 10/16/2025 & 11/20/2025 and did not observe any staff treating residents inappropriately or aggressively. One of three family members interviewed informed care to be attentive, and the help timely, as well has never seen anything negative.
Continue on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Shannan Hansen
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
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 5
Control Number 21-AS-20251013161836
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: MEADOW CREEK SENIOR LIVING
FACILITY NUMBER: 216804183
VISIT DATE: 11/20/2025
NARRATIVE
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Continued from LIC9099A

Four staff interviews were conducted. S2 indicated sometimes residents have bad days or are confused due to their dementia or have behaviors but all staff try to help the residents through these times. Outside parties (I2 & I3) who visit R1 at the facility at all different hours indicated there is no supporting information that could raise any concerns regarding or about the care residents are receiving at this facility. Law Enforcement report indicated did not believe anyone at the facility was in immediate danger or was being denied care or was neglected in any way. Case Closed. There was no information obtained that supported a violation had occurred.

Based on interviews conducted, observations, and Law Enforcement report obtained during the investigation, the allegation staff speaks inappropriately and aggressively to residents in care or treats the elders in the home badly is Unsubstantiated, meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Shannan Hansen
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5