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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486804072
Report Date: 04/21/2026
Date Signed: 04/21/2026 03:49:01 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
03/20/2026 and conducted by Evaluator Elias Magdaleno
COMPLAINT CONTROL NUMBER: 21-AS-20260320120237
FACILITY NAME:WARD RESIDENTIAL CARE HOME IIIFACILITY NUMBER:
486804072
ADMINISTRATOR:ANTONIO, ANNABELLEFACILITY TYPE:
740
ADDRESS:147 COLUMBIA WAYTELEPHONE:
(707) 917-6140
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY:6CENSUS: 6DATE:
04/21/2026
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Alicia Poquiz, Licensee TIME COMPLETED:
04:05 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff not meeting resident care needs
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At approximately 3:00PM, Licensing Program Analyst (LPA) Magdaleno arrived unannounced to continue a complaint investigation regarding the above allegation and met with Licensee Alicia Poquiz.

Staff not meeting resident care needs – Reporting Party (RP) alleges that resident (R1) is not receiving proper care related to their diagnosis and has not received any medical attention in four (4) years. During the course of this investigation LPA conducted interviews, made observations, and reviewed records. Review of current LIC602-Phsycian Report as well as hospital discharge paperwork indicated that R1 attended medical appointments two (2) times in 2026, and the previous LIC602-Physican Report was dated 5/2025. Review of Appraisal Needs and Service plan indicated that resident appraisal is being conducted yearly or upon a change in condition. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.
No deficiencies cited. Exit interview conducted with Licensee, whose signature on form confirms receipt.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Elias Magdaleno
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026
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 2
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
03/20/2026 and conducted by Evaluator Elias Magdaleno
COMPLAINT CONTROL NUMBER: 21-AS-20260320120237

FACILITY NAME:WARD RESIDENTIAL CARE HOME IIIFACILITY NUMBER:
486804072
ADMINISTRATOR:ANTONIO, ANNABELLEFACILITY TYPE:
740
ADDRESS:147 COLUMBIA WAYTELEPHONE:
(707) 917-6140
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY:6CENSUS: 6DATE:
04/21/2026
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Alicia Poquiz, LicenseeTIME COMPLETED:
04:05 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Unqualified staff providing care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At approximately 3:00PM, Licensing Program Analyst (LPA) Magdaleno arrived unannounced to continue a complaint investigation regarding the above allegation and met with Licensee Alicia Poquiz.

Unqualified staff providing care – RP alleges that facility operator left for an extended period of time and did not leave a qualified caregiver in place. Review of facility files indicated that Administrator has not left the facility and maintains a current Administrator certificate. Review of Personnel Report indicated that an additional certified Administrator was brought on to assist. Title 22 regulations do not require the licensee of a facility to maintain a specific number of hours on the premises. Review of facility files indicated that staff have received 37 hours of yearly training including the required 8 hours of Dementia, 8 hours of Medication Management, and 4 hours of postural supports/Hospice. Further review indicated staff have current First aid/CPR certificates. The department has found that the complaint allegation was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.
No deficiencies cited. Exit interview conducted with Licensee, whose signature on form confirms receipt.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Elias Magdaleno
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026
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 2