486803119-1-21-2026-21-AS-BMOS-DQRRDM-20260128115607

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803119
Report Date: 01/21/2026
Date Signed: 01/21/2026 01:42:21 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
01/08/2026 and conducted by Evaluator Star Stevenson

COMPLAINT CONTROL NUMBER: 21-AS-20260108102834

FACILITY NAME:	C & C RESIDENTIAL CARE HOME INC.		FACILITY NUMBER:	486803119
ADMINISTRATOR:	CORSIGA, ALMA		FACILITY TYPE:	740
ADDRESS:	2018 BLUEBIRD WAY		TELEPHONE:	(707) 344-2628
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94533
CAPACITY:	6	CENSUS: 5	DATE:	01/21/2026
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Licensee/Administrator- Alma Corsiga		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

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Resident's hygiene care needs are not being met.

INVESTIGATION FINDINGS:

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At approximately 01:30 PM, Licensing Program Analyst (LPA) Stevenson arrived unannounced to deliver complaint findings of a complaint received by Community Care Licensing on 01/08/2026.

Complainant alleged neglect/abuse of resident (R1) including poor incontinent care citing the use of two incontinent briefs with the client arriving to a local hospital with the two (2) briefs soaked with urine and fecal matter going up the front and back of R1’s clothes.

Interview with complainant revealed that R1 was otherwise in good condition and with R1’s groin and perianal area without redness, irritation, sloughing or urine scalding. Complainant also revealed that EMT staff will often relay if a community care home is run down, dirty or in bad shape. Complainant offered that EMT staff made no such claims about the facility R1 had come from.
Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 21-AS-20260108102834

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: C & C RESIDENTIAL CARE HOME INC.	FACILITY NUMBER: 486803119
	VISIT DATE: 01/21/2026

NARRATIVE

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Continued from LIC9099
During LPA’s unannounced complaint inspection, LPA noted facility to be very clean and without urine or fecal odors. Facility had very organized incontinence care items in each resident’s rooms including incontinence briefs with nylon Velcro-like attachments, Prevail-brand daily pant (incontinence brief) liners without velco-like attachments and “cloth-like outer fabric”. In addition, resident rooms and a separate supply area was noted to have incontinent wash spray and antibacterial barrier skin creams.

Interview with resident R2 indicated no concern about their incontinence care at the facility.

During the course of the investigation LPA obtain R1’s Physician’s Assessment and Care Plan that indicated the need for help with bowel and bladder incontinence care, including help with incontinence briefs and help with toileting and grooming. In addition, R1 was noted to be on a pureed/liquid/thickened diet and took PRN medicines for anxiety.

Interviews with S1 and S2 reveal that on the morning of R1s admission to the hospital, R1 had an incontinence brief and an additional incontinence liner as a precaution for travel to day programming. On that morning R1 had vomited and began to become short of breath with a temperature of 101.5F and 911 was contacted. Staff noted that R1 was incontinent of bowel and bladder and while taking vitals, R1 vomited and began to slump in the arms of facility staff. Staff S1 and S2 expressed an immediate urge in a situation that felt dire, to help R1 onto an awaiting EMT gurney and get R1 to the hospital. S1 and S2 acknowledged that facility residents are always ensured to be clean and dry, especially for outings like day programming or medical visits, but on this day, it did not make sense for R1, given the urgent nature of their concerns for R1, R1’s history of anxiety and R1’s preference to be changed in standing positing. The allegation is Unsubstantiated.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.

This report was reviewed with Licensee/Administrator Alma Corsiga, whose signature denotes receipt.

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026

LIC9099 (FAS) - (06/04)

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