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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496800937
Report Date: 03/20/2026
Date Signed: 03/20/2026 02:20:23 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
03/13/2026 and conducted by Evaluator Marisol Cuadra
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20260313094427
FACILITY NAME:SARAH'S SENIOR RESIDENTIAL CAREFACILITY NUMBER:
496800937
ADMINISTRATOR:ARAYA, SARAHFACILITY TYPE:
740
ADDRESS:1601 CLOVER DRIVETELEPHONE:
(707) 542-4082
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY:6CENSUS: 4DATE:
03/20/2026
UNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Juanita McDaniel (Back up Administrator)TIME COMPLETED:
02:43 PM
ALLEGATION(S):
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-Staff did not follow proper reporting requirements.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cuadra conducted an unannounced visit and met with Back up Administrator, Juanita McDaniel. Licensee, Sarah Lawrence arrived later. The purpose is to investigate complaint allegation listed above and delivered findings. The Department received an allegation of staff did not follow proper reporting requirements. Per Reporting Party, on 2/19/26 there was a suspected abuse incident report filed involving client (C1) where the facility staff requested an earlier medical evaluation for C1 and notified C1's psychiatrist. During today's visit, LPA conducted interviews with Licensee and Back up Administrator confirmed that placement agency and Community Care Licensing were not notified about the incident because they were under the impression that since the suspected incident didn't happen at the facility, they did not need to report it to pertinent agencies. Based on records review, staff provided LPA with incident report dated 3/6/26 about suspected incident that happened at a different location. However, facility staff did not follow reporting requirements and did not report it to pertinent agencies. The suspected abuse is being investigated under complaint #21-AS-20260313091722. The preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. Health and Safety Code is being cited on the attached LIC 9099D. Appeal Rights Given.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2026
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-20260313094427
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: SARAH'S SENIOR RESIDENTIAL CARE
FACILITY NUMBER: 496800937
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/20/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/20/2026
Section Cited
CCR
87211(a)(1)(D)
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87211(a)(1)(D) Reporting Requirements. The licensee shall send a written report, within seven days, to the licensing agency and the person responsible for the resident when any incident occurs which threatens the welfare, safety or health of any resident. This requirement is not met as evidence by:
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Licensee to ensure incidents are reported per regulation. Also, all staff will review regulation 87211, and conduct training for all staff on reporting requirements. Evidence of completed training to be submitted to CCL by POC date of 4/20/2026.
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Based on LPA's records review and interview with the Licensee, Licensee failed to report incident involving C1 that threatened the safety or health of residents. This poses a potential health or safety risk to 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: 03/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2026
LIC9099 (FAS) - (06/04)
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