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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486802085
Report Date: 01/29/2026
Date Signed: 01/29/2026 03:09:30 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
11/03/2025 and conducted by Evaluator Ethel Contreras
COMPLAINT CONTROL NUMBER: 21-AS-20251103153410
FACILITY NAME:BUCK SERENITY HOMESFACILITY NUMBER:
486802085
ADMINISTRATOR:CASTRO, GIDEONFACILITY TYPE:
740
ADDRESS:691 BUCK AVENUETELEPHONE:
(707) 449-8394
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY:6CENSUS: 4DATE:
01/29/2026
UNANNOUNCEDTIME BEGAN:
11:27 AM
MET WITH:Gideon Castro-Administrator TIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff do not ensure resident's bathing needs are being met
Staff admitted a resident who required a higher level of care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Contreras arrived unannounced to deliver complaint findings regarding complaint #21-AS-20251103153410. LPA was greeted by administrator (admin) Gideon Castro. During the investigation, the Department requested and reviewed documents, conducted interviews and made observations.

Complaint alleges staff admitted a resident who required a higher level of care and staff do not ensure resident's bathing needs are being met. Complainant states that resident (R1) was not showered by facility staff due to R1’s large size which requires a two-person assist. During the investigation, LPA reviewed R1’s Preplacement appraisal completed and signed by licensee on 9/24/25. Preplacement appraisal indicates that upon admission, the facility concluded that R1 needed help with bathing, hair care, and personal hygiene; moreover, it was assessed that R1 needed a two-person assist. The Preplacement appraisal also indicates that R1 needed a two-person assist when needing help with transferring in and out of bed and dressing.
Continued onto 9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Ethel Contreras
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026
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 5
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
11/03/2025 and conducted by Evaluator Ethel Contreras
COMPLAINT CONTROL NUMBER: 21-AS-20251103153410

FACILITY NAME:BUCK SERENITY HOMESFACILITY NUMBER:
486802085
ADMINISTRATOR:CASTRO, GIDEONFACILITY TYPE:
740
ADDRESS:691 BUCK AVENUETELEPHONE:
(707) 449-8394
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY:6CENSUS: 4DATE:
01/29/2026
UNANNOUNCEDTIME BEGAN:
11:27 AM
MET WITH:Gideon Castro-Administrator TIME COMPLETED:
03:30 PM
ALLEGATION(S):
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9
Illegal Eviction
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Contreras arrived unannounced to deliver complaint findings regarding complaint #21-AS-20251103153410. LPA was greeted by administrator (admin) Gideon Castro. During the investigation, the Department requested and reviewed documents, conducted interviews and made observations.

Complaint alleges facility issued an Illegal eviction. Complainant states that on 11/3/25 R1’s responsible party was given a verbal message, as well as a text, stating licensee was giving R1 a 30 day notice of eviction. During the investigation, licensee advised LPA that they “could not handle” R1’s care any longer because R1 had “too many changes of condition.” Licensee advised LPA during preplacement it was determined that R1 was only a one person assist, according to facility’s assessment. However, licensee claims that R1 was now requiring a two-person assist which is a higher level of care than previously identified.

Continued to 9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Ethel Contreras
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 21-AS-20251103153410
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: BUCK SERENITY HOMES
FACILITY NUMBER: 486802085
VISIT DATE: 01/29/2026
NARRATIVE
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continued from 9099-A.....

During investigation, LPA reviewed R1’s Preplacement appraisal which indicates that, upon admission, the facility concluded that R1 required a two-person assist. The Preplacement appraisal also indicates that R1 needed a two-person assist when needing help with transferring in and out of bed and dressing. Licensee advised LPA that additional reason for eviction was that he was sick of R1’s responsible party’s demands. LPA advised licensee of regulation 87224 which provides the conditions under which a resident can be lawfully evicted.

Licensee did not issue a formal written eviction notice, only a text message indicating his frustration and desire to have R1 find another home. R1 subsequently left the facility. However, R1 was not removed from the facility by licensee, R1 left of their own accord. So, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.


Copy of report read and given to administrator
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Ethel Contreras
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 21-AS-20251103153410
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: BUCK SERENITY HOMES
FACILITY NUMBER: 486802085
VISIT DATE: 01/29/2026
NARRATIVE
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continued from 9099....

During the investigation, licensee advised LPA that they “could not handle” R1’s care any longer because R1 had “too many changes of condition". Licensee advised LPA during preplacement it was determined that R1 was only a one person assist, according to facility’s assessment. However, licensee claims that R1 was now requiring a two-person assist which is a higher level of care than previously identified. During investigation, LPA reviewed R1’s Preplacement appraisal which indicates that, upon admission, the facility concluded that R1 required a two-person assist.

The Preplacement Appraisal also indicates that R1 needed a two-person assist when needing help with transferring in and out of bed and dressing. LPA reviewed R1’s Admission Agreement, which lists the basic services provided by the facility will include, at a minimum, assistance with bathing. LPA requested proof of facility providing showers to R1 but facility could not produce a shower log or any documentation of facility providing showers. Additionally, during the investigation, LPA conducted interviews. Witness (W1) reported to LPA that facility staff refused to give R1 showers due to R1’s large size and having to use a Hoyer lift; instead, they would give R1 bed baths. W1 reported to LPA that the only showers R1 received were provided by non-facility staff.

Therefore, based on LPA’s interviews and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 Chapter 8, are being cited on the attached 9099-D.

Copy of report read and given to administrator. Appeal rights given.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Ethel Contreras
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 21-AS-20251103153410
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: BUCK SERENITY HOMES
FACILITY NUMBER: 486802085
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/29/2026
Section Cited
HSC
1569.269(a)(6)
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§1569.269Enumerated rights(a) Residents of residential care facilities for the elderly 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. This requirement has not been met as evidence by:
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Facility to submit plan to register all staff to participate/attend the ombudsman training for personal rights. Facility to submit plan to contact the local ombudsman to facilitate personal rights training for all staff by plan of correction due date. Facility to get the date of the next personal rights training and provide
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Based on records review, observations and interviews conducted Licensee did not ensure to services needs were provided necessary to meet individual care needs which poses an immediate risk to the health and safety of residents in care.
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 the date to CCL by no later than 2/04/25.
Once attendance/ participation is completed facility to submit training certificate or record showing all staff in attendance, hours of attendance, date of attendance, and instructor name. Training to be completed by 3/01/2026.
Type A
01/29/2026
Section Cited
HSC
87464(f)(4)
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Basic Services 87464(f)(4) Personal assistance and care...as indicated in the pre admission appraisal, with those activities of daily living such as...bathing... This requirement is not met as evidenced by: Based on record review and interviews
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Licensee to submit self certification that staff will be trained on documenting all bathing needs and refusals for all residents as indicated in their admissions agreement .In addition licensee to submit weekly bathing logs for the following 3 weeks to CCLD
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Staff refused to give R1 showers due to R1’s large size and facility was not able to provide documentation of shower logs.
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Licensee to submit self certification to CCL by Plan of Correction due date of 1/30/2026
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: Ethel Contreras
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5