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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 286803898
Report Date: 05/29/2026
Date Signed: 05/29/2026 05:41:52 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
05/01/2026 and conducted by Evaluator Julie Florio
COMPLAINT CONTROL NUMBER: 21-AS-20260501103545
FACILITY NAME:PINK LADY CAREHOME, LLC.FACILITY NUMBER:
286803898
ADMINISTRATOR:MARY GRACE DEFEOFACILITY TYPE:
740
ADDRESS:39 VIA MARCIANATELEPHONE:
(707) 731-2345
CITY:AMERICAN CANYONSTATE: CAZIP CODE:
94503
CAPACITY:6CENSUS: 1DATE:
05/29/2026
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Teresita Buenavista, CaregiverTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Staff is financially abusing residents.
INVESTIGATION FINDINGS:
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On 05/29/2026, at approximately 4:00 PM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to deliver complaint investigation findings regarding LIC802 - Complaint Report #21-AS-20260501103545, which was received by Community Care Licensing (CCL) on 05/01/2026. LPA met with Teresita Buenavista, Caregiver. Licensee was contacted by caregiver via telephone and was unable to attend today's visit.

On 05/08/2026 and 05/21/2026, LPA conducted interviews and obtained documents which all revealed that Resident 1 (R1) did not give written notice that they would be moving out of the facility nor was there any evidence to support the any portion of the month's rents was due to be refunded to R1 by the Licensee. Further, R1's admissions agrrement dated 05/12/2024 and signed by R1's responsible party does not indicate whether the "total monthly amountly rate set forth in the admissions agreement will" or

Continued on LIC9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2026
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-20260501103545
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: PINK LADY CAREHOME, LLC.
FACILITY NUMBER: 286803898
VISIT DATE: 05/29/2026
NARRATIVE
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Continued from LIC9099...

"will not be prorated on a daily basis upon the resident's admission to, permanent departure from, the facility during the month."

While record review revealed that R2 had purchased groceries for themself on at least one occasion, an interview with R2 revealed that they purchased groceries for themself and to share with other's in the facility, because they wanted pricier, specific, bulk food items and they chose to share with others in the facility. Interviews further revealed that R2 was not asked to purchase food for themself or the facility staff or residents, but rather R2 did so on their own volition. Interviews with R2 and the Licensee further revealed that the facility staff prepared separate items for R2 in addition to the meals prepared for the rest of the facility residents and did not charge R2 extra fees for the added service. Based on interviews conducted and documents obtained, the Department received conflicting information.

Based on interviews conducted, observations made, and records obtained, the allegation that staff is financially abusing residents is UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that 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.

No deficiencies cited.

Exit interview conducted with Teresita Buenavista, Caregiver, whose signature on form confirms receipt of document(s).
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2