486803822-1-30-2025-21-AS-KMOA-DDJNDM-20250203092234

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803822
Report Date: 01/30/2025
Date Signed: 01/30/2025 03:12:09 PM

Unsubstantiated

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
01/09/2025 and conducted by Evaluator Jill Nakagawa

COMPLAINT CONTROL NUMBER: 21-AS-20250109092615

FACILITY NAME:	MAGNOLIA COURT		FACILITY NUMBER:	486803822
ADMINISTRATOR:	MOSES, CANDICE		FACILITY TYPE:	740
ADDRESS:	1111 ULATIS DR		TELEPHONE:	(707) 447-7100
CITY:	VACAVILLE	STATE: CA	ZIP CODE:	95687
CAPACITY:	146	CENSUS: 75	DATE:	01/30/2025
		UNANNOUNCED	TIME BEGAN:	12:55 PM
MET WITH:	Candice Moses, Administrator and Gina Lapid,Memory Care Director		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Residents not provided proper nutritional needs
Staff does not ensure residents grooming needs are met
Lack of supervision resulting in falls

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to continue an investigation regarding the above allegations. LPA Nakagawa met with the Administrator Candice Moses and the Memory Care Coordinator Gina Lapid to discuss.

During the course of the investigation, LPA conducted unannounced inspections on 01/09/2025 and 01/30/2025, made observations, reviewed records, and interviewed staff and others. Due to no contact information, LPA was unable to obtain further information from the reporting party.
It is alleged that Residents are not provided proper nutritional needs. LPA toured the facility kitchen on 01/09/2025 and found an ample supply of fresh and frozen foods to supply the menu choices which are provided to all residents: Assisted Living and Memory Care communities.

Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025

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-20250109092615

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: MAGNOLIA COURT	FACILITY NUMBER: 486803822
	VISIT DATE: 01/30/2025

NARRATIVE

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Continued from 9099....
Staff (S1) stated that all residents are given multiple choices at each meal. A copy of the menu was provided to LPA. At the time of inspection five (5) residents require pureed or mechanical soft diets but receive the same foods but prepared as ordered by physician. LPA was told by Staff (S2) that meal service in Memory Care is brought over from the central kitchen and served by care staff. Through interviews, LPA was informed that some residents require their food cut up, others prefer finger foods, and some use utensils, some require cueing and others are fed. Residents in the dining area are observed during meals by care staff; several residents have records kept on their intake. Residents are weighed each month and weight loss is reported to doctors and responsible parties. Residents in Memory Care are served three snacks in addition to three meals a day. Hydration breaks are also given throughout the day by the Medication Technician and the Activities Director. Based on the evidence, the allegation that Residents are not provided proper nutritional needs is unsubstantiated. 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.

It is alleged that Staff does not ensure residents grooming needs are met. LPA toured the Memory Care community on 01/09/2025 and 01/30/2025. At the time of the inspection on 01/09/2025 LPA observed 15 of 28 residents and 20 of 28 residents on 01/30/2025: some resting in their rooms, some in the Activities Room watching a church service/TV, others in the Dining Room socializing. LPA found them to be physically clean, dressed appropriately in clean clothes, hair combed. Men appeared to be shaven recently. Memory Care requires that residents do not have access to sharp objects and so residents must have nails cut. Although several residents observed had longer nails; nail beds were clean and grooming needs were met. Therefore the allegation that Staff does not ensure residents grooming needs are met is unsubstantiated.

Continued on 9099-C2

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 21-AS-20250109092615

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: MAGNOLIA COURT	FACILITY NUMBER: 486803822
	VISIT DATE: 01/30/2025

NARRATIVE

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Continued from 9099-C

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.

It is alleged that Lack of supervision resulting in falls. LPA reviewed staffing records and found that there are three care staff and a medication technician scheduled per shift. There are additional personnel during regular working hours including the Activities Director and the Memory Care Resident Care Coordinator (five days per week). Residents are closely supervised in the common areas of the memory care unit and there is a call bell system in the bathrooms of all rooms. Staff (S1) stated that all residents are checked on regularly throughout their shifts. Based on the evidence the allegation Lack of supervision resulting in falls is unsubstantiated. 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 citations issued.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025

LIC9099 (FAS) - (06/04)

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