486803822-4-1-2025-21-AS-KMOA-DGVVE5-20250521162146

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803822
Report Date: 04/01/2025
Date Signed: 04/01/2025 04:19:53 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
03/06/2025 and conducted by Evaluator Jill Nakagawa

COMPLAINT CONTROL NUMBER: 21-AS-20250306150522

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: 84	DATE:	04/01/2025
		UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Candice Moses, Administrator and Gina Lapid, Memory Care Director		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Facility has insufficient food service.
Residents are not accorded dignity in their relationship with staff.
Staff do not provide activities for all residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct an investigation regarding the above allegations on 3/11/2025 and 04/01/2025. LPA Nakagawa met with the Administrator Candice Moses and the Memory Care Coordinator Gina Lapid to discuss.
Regarding the allegation Facility has insufficient food service: LPA toured the facility kitchen on 04/01/2025 and found an ample supply of fresh and frozen foods to supply the menu choices. The chef stated that all residents in Assisted Living and Memory Care communities are given the same multiple choices at each meal. A copy of the menus for 03/02/2025 through 04/05/2025 was provided to LPA. LPA was told by staff Memory Care Director Gina Lapid that meal service in Memory Care is brought over from the central kitchen pre-plated and served by care staff.

Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:	DATE: 04/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2025

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-20250306150522

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: 04/01/2025

NARRATIVE

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Continued from 9099....

These meals are the same as those served in the main dining room, although some are specially prepared as some residents require their food pureed or cut up, others prefer finger foods. Other considerations in serving food in Memory Care include cueing, special utensils or feeding. At the time of inspection three (3) residents require pureed or mechanical soft diets. Residents in the dining area are observed during meals by care staff with assistance in cueing or eating given, as needed. On 03/11/2025 and 04/01/2025 LPA observed lunch service with staff encouraging residents to eat and to offer additional portions. Several residents have records kept on their intake. Residents are weighed each month and weight loss is reported to doctors and responsible parties. Recent weight records uncovered one resident (R1) who was losing weight. Responsible party and doctor were notified, adjustments were made quickly and resident has been steadily gaining weight. According to S2, many residents in Memory Care put on weight due to the attention and oversight they receive throughout the day and especially during meals. Residents in Memory Care are served three snacks 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 Facility has insufficient food service 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.

Regarding the allegation Residents are not accorded dignity in their relationship with staff: LPA observed staff/residents interactions on two (2) occasions (03/11/2025 and 04/01/2025) and found no incidents of staff treating residents in an undignified manner. LPA spoke with family members, home health employees and care staff, as well as three (3) residents. Eleven (11) of eleven (11) individuals all agreed that staff treated residents with respect and dignity. Based on the evidence, the allegation that Residents are not accorded dignity in their relationship with staff 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.
Continued on 9099-C(2)

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:	DATE: 04/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 21-AS-20250306150522

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: 04/01/2025

NARRATIVE

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Continued from 9099-C

Regarding the allegation Staff do not provide activities for all residents: LPA Nakagawa has made multiple visits to the facility and found activities taking place. The facility has activities personnel for both the Assisted Living (AL) and Memory Care residents and when they are off care staff conduct activities with residents. LPA found posted Activities Calendars (as required by Title 22 Regulations) for both Memory Care and Assisted LIving, including Exercise Classes, Puzzles, Board Games, Walking Club, Manicures, Movie Nights, monthly Birthday Celebrations, Painting and Cooking, and of course, Bingo. On 04/01/2025, at the time of inspection, LPA found 22 of 28 residents taking part in a game of Bingo with staff S1. Three (3) other residents were in a room adjacent to the activity watching TV in the living room. This was primarily the same scenario LPA found on past visits (01/30/2025, 03/11/2025). Staff (S2) stated that residents who refuse/choose not to participate in activities are encouraged to be in proximity to the group so they can passively participate, but residents cannot be forced to participate. At the same time, there were three (3) residents resting in their rooms. Based on the evidence, the allegation that Staff do not provide activities for all residents 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: 04/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2025

LIC9099 (FAS) - (06/04)

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