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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486804180
Report Date: 11/06/2025
Date Signed: 11/06/2025 10:12:27 AM

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
10/09/2025 and conducted by Evaluator Star Stevenson
COMPLAINT CONTROL NUMBER: 21-AS-20251009124401
FACILITY NAME:AGING IN THE BAY 4FACILITY NUMBER:
486804180
ADMINISTRATOR:MENDAROS, CHARMAINEFACILITY TYPE:
740
ADDRESS:2290 CORMORANT DRIVETELEPHONE:
(510) 388-7352
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:6CENSUS: 3DATE:
11/06/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Caregiver Mary Ann OrdonoTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Staff spoke inappropriately to resident.
Staff handled resident in a rough manner.
INVESTIGATION FINDINGS:
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At approximately 09:15 AM Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to deliver compliant findings for compliant 21-AS-20251009124401 and was greeted by staff Mary Ann Ordono who called licensee Charmaine Mendaros, who gave Mary Ann Ordono permission to sign for today's complainant visit. Reporting party alleged that facility staff spoke to a resident in an inappropriate manner and handled a resident in a rough manner.

During complaint investigation, LPA conducted two(2) resident, three(3) staff and one(1) outside caregiver interview, made observations, and performed file reviews. In addition LPA, observed video footage and obtained documents. Interviews, document review and personal observation revealed that resident (R1) has a diagnosis of dementia, as well as hallucinations. Interview with outside care staff revealed that R1 has a documented history of violent-themed hallucinations at times. Interviews with staff, outside care staff and another resident revealed that staff (S1) is well liked and has no history of foul language or rough care with residents. During the course of the investigation the LPA was unable to obtain information to support the above allegations.

Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
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-20251009124401
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: AGING IN THE BAY 4
FACILITY NUMBER: 486804180
VISIT DATE: 11/06/2025
NARRATIVE
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Continued from LIC9099

Based on observations made, interviews conducted, and records reviewed, the department received conflicting information regarding allegations above.

Based on interviews conducted and records obtained, the allegation that facility staff spoke inappropriately to a resident and that staff handled a resident in a rough manner is UNSUBSTANTIATED. A finding that a complaint allegation 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.

No deficiencies cited.

Exit interview conducted with Caregiver Mary Ann Ordono, whose signature on form confirms receipt of document(s).
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2