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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 286802019
Report Date: 03/10/2025
Date Signed: 03/10/2025 11:16:19 AM

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
10/11/2024 and conducted by Evaluator Christopher Arnhold
COMPLAINT CONTROL NUMBER: 21-AS-20241011110338
FACILITY NAME:LINDA FALLS GUEST HOME 1FACILITY NUMBER:
286802019
ADMINISTRATOR:SACRO, NORBERTFACILITY TYPE:
740
ADDRESS:755 LINDA FALLS TERRACETELEPHONE:
(707) 963-1440
CITY:ANGWINSTATE: CAZIP CODE:
94508
CAPACITY:6CENSUS: DATE:
03/10/2025
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Lino CaramatTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Neglect/lack of supervision resulting in a severe injury

Faciltiy failed to seek timely medical
INVESTIGATION FINDINGS:
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At approximately 8:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an investigation into the above allegations. LPA was greeted by caregiver Lino Caramat as Administrator Norbert Sacro was not present at the time of this visit. LPA reviewed documents and interviewed staff. At approximately 8:45AM, LPA reviewed Resident, R1, file and observed the file did not contain evidence of a medical examination prior to admission, no Pre-admission appraisal and no care plan. R1 was admitted to the facility 05/23/2023. LPA observed the file contained a letter sent to the responsible party on 09/15/2024,stating R1 needed a higher level of care. A similar letter was also in the file dated 09/26/2024. The letter dated 09/26/2024 appears to be a formal 60 day eviction notice. Neither of these documents were sent to Community Care Licensing at the time. LPA observed a handwritten note in the file dated 05/26/2023 explaining a Registered Nurse, W1, came to evaluate R1 for home health services. There was a second note dated 02/09/2024, noting a telephone call to a physician requesting a home health visit commenting on declining health and a worsing wound. There was no documentation of when and what medical treatment was sought. Continued on LIC9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025
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 3
Control Number 21-AS-20241011110338
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: LINDA FALLS GUEST HOME 1
FACILITY NUMBER: 286802019
VISIT DATE: 03/10/2025
NARRATIVE
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Based on records reviewed, LPA observed the Licensee was aware of a worsening pressure injury on 02/09/2024 and sought medical assistance. There are no follow up documents regarding the care of R1. Licensee made an attempt to evict R1 in September 2024 noting concerns with declining health conditions. Based on records available during this visit, there was no evidence Licensee sought medical attention for R1 after the 02/09/2024 telephone call. R1's condition continued to decline until R1 was taken to the Hospital on 10/05/2024.
Based on records reviewed, the allegations of Neglect/lack of supervision resulting in a severe injury and Facility failed to seek timely medical are determined to be Substantiated.
As a result of these violations, an immediate civil penalty is being issued in the amount of $500.00

Based on the Departments investigation, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED.

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
This report was reviewed with Lino Caramat and Appeal rights were given.


The licensee was informed that a civil penalty might be assessed based on Health and Safety Code 1569.49 or 1548, 1568.0822.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 21-AS-20241011110338
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: LINDA FALLS GUEST HOME 1
FACILITY NUMBER: 286802019
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/11/2025
Section Cited
CCR
87465(a)(2)
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87465 Incidental Medical and Dental Care: (2) The licensee shall provide assistance in meeting necessary medical and dental needs. This requirement is not met as evidenced by: Based on records reviewed, Licensee did not ensure R1 received timely medical care for a worsing wound. This
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Licensee Shall conduct retraining for all staff on the care and supervision of residents. Evidence of completed training shall be submitted to CCLD by 03/11/2025.
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poses an Immediate Health, Safety or Personal Rights risk to persons in care.
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Type A
03/11/2025
Section Cited
CCR
87466
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87466 Observation of the Resident: The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. This requirement is not met as evidenced by:
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Licensee Shall conduct retraining for all staff on the care and supervision of residents. Evidence of completed training shall be submitted to CCLD by 03/11/2025.
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Based on records reviewed, LIcensee did not ensure resident received ongoing medical care for a worsening wound, resulting in residents hospitalizion. This poses an Immediate Health, Safety or Personal Rights risk to persons in care. An immediate Civil Penalty is being issued 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: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3