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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803822
Report Date: 12/11/2025
Date Signed: 12/11/2025 01:48:40 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
10/29/2025 and conducted by Evaluator Jill Nakagawa
COMPLAINT CONTROL NUMBER: 21-AS-20251029092654
FACILITY NAME:MAGNOLIA COURTFACILITY NUMBER:
486803822
ADMINISTRATOR:SORIANO, KRISTINEFACILITY TYPE:
740
ADDRESS:1111 ULATIS DRTELEPHONE:
(707) 447-7100
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY:146CENSUS: 84DATE:
12/11/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Kristine Soriano, AdministratorTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Staff are not ensuring resident is showered
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nakagawa arrived unannounced at the facility to conclude the complaint investigation regarding the above allegation and to deliver findings. LPA met with Administrator Kristine Soriano.

The complaint alleges that Staff are not ensuring resident (R1) is showered. The complainant states that since moving into the facility in May 2025, R1 has had a problem with showering and facility has not provided the shower standby assistance agreed to in R1's care plan. LPA reviewed R1's care notes and shower sheets and discovered that R1 was not always the one refusing showering.
Continued on 9099-C...

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
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-20251029092654
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: 12/11/2025
NARRATIVE
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Continued from 9099....

Records indicate that R2 (R1’s roommate) would refuse a caregiver permission to enter the room to shower R1. R1 has a diagnosis of dementia and R2 is not the Responsible Party (RP) for R1. R1's RP was interviewed by LPA, who stated they are aware of the issue and feel that R1 is getting showers, although not regularly, there has not been any medical concerns. Although the allegation Staff is not ensuring resident is showered may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did nor did not occur, therefore the allegation is unsubstantiated.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2