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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803946
Report Date: 06/03/2026
Date Signed: 06/03/2026 02:58:53 PM

Substantiated


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
04/21/2026 and conducted by Evaluator Marisol Cuadra
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20260421104844
FACILITY NAME:PARKSIDE MANORFACILITY NUMBER:
486803946
ADMINISTRATOR:ALINIO, RUBYFACILITY TYPE:
740
ADDRESS:50 CADLONI LNTELEPHONE:
(707) 557-8991
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:17CENSUS: 13DATE:
06/03/2026
UNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Rosella Kuhn (staff)TIME COMPLETED:
03:13 PM
ALLEGATION(S):
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-Personal Rights.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a complaint investigation and delivered findings regarding the allegation listed above and met with Rosella Kuhn, staff. Administrator Ruby Alinio was not able to come to the facility but they were available over the phone and gave authorization for designated staff to sign the report.

The Department received an allegation of personal rights. The Reporting party has concerns that staff (S1) are verbally abusing resident (R1) after inquiring about bruising noticed in R1’s arms and hands. During the course of investigation, LPA conducted 10-day visit on 04/24/26, made observations, reviewed records and conducted interviews. Upon administrator’s arrival, Administrator approached R1 to inquire about R1’s debit card missing, R1 stated that S1 stole the debit card where they receive their income from government benefits. Administrator called S1 to inquire about R1’s verbal statement, S1 raised their tone of voice to ask R1 why they were under the impression that they had the card missing.
Continued on LIC9099C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2026
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
Control Number 21-AS-20260421104844
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: PARKSIDE MANOR
FACILITY NUMBER: 486803946
VISIT DATE: 06/03/2026
NARRATIVE
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Continued from LIC9099...

LPA witnessed this incident and administrator touched S1 kindly indicating that they could not talk to R1 in that manner. Per administrator, S1 reacted like that due to R1 accusing them of stealing their debit card. Also, during visit, Administrator told LPA about R1's bruising in their arms due to skin condition. However, there was no LIC602 physician report on file because R1 doesn’t have health insurance at this moment. Based on review of R1’s records, the facility has been in constant communication with pertinent agencies to resolve this issue. Based on interviews conducted with residents (R1, R2 & R3) it was confirmed that S1 raises their voice to residents and frequently ignores their requests for assistance. The preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is cited on the attached LIC 9099D. Appeal Rights Given. The Administrator was informed that additional civil penalties are under review by the Department by the Health and Safety Code 1569.49 (f).
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 21-AS-20260421104844
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: PARKSIDE MANOR
FACILITY NUMBER: 486803946
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/03/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/04/2026
Section Cited
HSC
1569.269(a)(1)
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Type A: §1569.269 Enumerated rights; severability (a) Residents of residential care facilities for the elderly shall have all of the following rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement has not been met as evidence by:
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The administrator agrees to contact the Ombudsman or outside agency to schedule personal rights training for all staff including S1. The administrator will ensure residents’ rights are not violated, then submit proof of enrollment to a personal rights training provider to clear the citation by POC due date 6/4/2026.
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Based on LPA’s/Administrator’s observations and interviews with residents in care, S1 did not ensure that residents’ personal rights were not violated by raising their voice to residents in care, which poses an immediate risk to the health and safety of residents in care.
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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: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5
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
04/21/2026 and conducted by Evaluator Marisol Cuadra
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20260421104844

FACILITY NAME:PARKSIDE MANORFACILITY NUMBER:
486803946
ADMINISTRATOR:ALINIO, RUBYFACILITY TYPE:
740
ADDRESS:50 CADLONI LNTELEPHONE:
(707) 557-8991
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:17CENSUS: 13DATE:
06/03/2026
UNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Rosella Kuhn (staff)TIME COMPLETED:
03:13 PM
ALLEGATION(S):
1
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9
-Financial Abuse.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a complaint investigation and delivered findings regarding the allegation listed above and met with Rosella Kuhn, staff. Administrator Ruby Alinio was not able to come to the facility but they were available over the phone and gave authorization for designated staff to sign the report.

The Department received an allegation of financial abuse. Per Reporting party, resident (R1) told them that facility has stolen their direct express card where their government benefits get deposited and R1 doesn’t have access to their money. On 4/24/26, LPA conducted 10-day visit, made observations, reviewed records and conducted interviews with staff and residents. Based on interviews conducted with R1, they were unable to determine if any agency or individual manages their finances but thinks that S1 stole their debit card. Administrator disclosed that R1 was brought to the facility without any background of their source of income, and the county is assuming that they might have a conservator, but the facility doesn’t have any documentation to prove or disprove it. Continued from LIC9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2026
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-20260421104844
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: PARKSIDE MANOR
FACILITY NUMBER: 486803946
VISIT DATE: 06/03/2026
NARRATIVE
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Continued from LIC9099A...

The county recently lowered R1’s monthly payment from $3500 to $1939, which goes directly to Parkside Manor through Adobe Services, which is R1’s payee services. LPA was provided with paystubs confirming above information and the existence of debit card. Interviews conducted by LPA with S1 stated that R1’s male friend who comes to visit R1 and stays outside could have taken it from them, but it is unclear if this statement is true or not. Upon learning of stolen debit card, administrator called the social security office to stop any payments been made through that debit card. On 5/15/2026, LPA received written confirmation from the facility that R1 has in their possession a new debit card after they instructed them to never share it or their password with anybody else. Currently, the facility is processing their medical insurance using their government benefits as proof of income. Based on records review and interviews conducted LPA is unable to determine if facility staff could have been financially abusing R1. A finding that the complaint allegation financial abuse is unsubstantiated means that 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.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5