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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496803071
Report Date: 10/30/2025
Date Signed: 10/30/2025 03:47:47 PM

Substantiated


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
08/19/2025 and conducted by Evaluator Robert Frank
COMPLAINT CONTROL NUMBER: 21-AS-20250819170640
FACILITY NAME:BURBANK MANORFACILITY NUMBER:
496803071
ADMINISTRATOR:GREGORIO, ARLINDAFACILITY TYPE:
740
ADDRESS:612 HENDLEY STREETTELEPHONE:
(707) 542-2065
CITY:SANTA ROSASTATE: CAZIP CODE:
95404
CAPACITY:6CENSUS: 6DATE:
10/30/2025
UNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Arlinda Gregorio, AdministratorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility is having financial issues
Outdoor sheds are being used for sleeping
INVESTIGATION FINDINGS:
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At approximately 11:50 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to deliver Complaint findings regarding the above allegations and met with facility Administrator Arlinda Gregorio.

During the course of the investigation LPAs Frank and Nakagawa conducted multiple facility visits, conducted interviews, collected and reviewed documents.

Complaint alleges the facility is have financial Issues. Reporting Party stated that Licensee is two (2) months behind on rent when the complaint was filed on 8/19/2029. In interviews conducted with licensee Arlinda Gregorio on 8/20/2025 and on 10/1/2025 the licensee stated due to a decreased occupancy of residents at the facility they were unable to submit rent for 7/2025,8/2025 and 9/2025 by the due date per the property lease.

Continued on LIC 9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
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 5
Control Number 21-AS-20250819170640
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: BURBANK MANOR
FACILITY NUMBER: 496803071
VISIT DATE: 10/30/2025
NARRATIVE
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...Continued from LIC 9099

The rent for 7/2025 and 8/2025 were paid on 8/30/2025. The rent for 9/2025 was paid on 9/26/2025. The rent for 10/2026 was paid on time per the lease. Based on LPA’s interviews and expressed admission, 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, are being cited on the attached 9099D.

Complaint alleges that an outside shed is being used for sleeping. During Terminix pest elimination company’s 7/1/2025 service visit the facility would not allow the inspector in the outside shed because an individual was sleeping in the shed. The facility has a large, finished two room shed in the back yard. The shed has not been approved by the fire department for occupancy. During an 8/20/2025 inspection LPA observed that the room contained dressers, hanging cloths, guitars on guitar stands as well as a desk area that had an empty can of soda and a piece of fruit. LPA further observed a full size mattress and box springs on a wooden bed frame. The shed was observed with a window air conditioner. During an inspection on 9/18/2025 LPA observed that the desk area had been cleaned and that the bed had been replaced with a couch. LPAs took Photographs of the shed during both inspections. In an interview the Licensee noted that the shed had been used as a break area in the past. Based on LPA’s interviews and observations, 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, are being cited on the attached 9099D.

Exit interview conducted. Copy of LIC-9099, LIC-9099-C, LIC-9099D, Plan of Corrections and Appeal Rights discussed and provided to Administrator Gregorio. Signature on form confirms receipt of documents.

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
08/19/2025 and conducted by Evaluator Robert Frank
COMPLAINT CONTROL NUMBER: 21-AS-20250819170640

FACILITY NAME:BURBANK MANORFACILITY NUMBER:
496803071
ADMINISTRATOR:GREGORIO, ARLINDAFACILITY TYPE:
740
ADDRESS:612 HENDLEY STREETTELEPHONE:
(707) 542-2065
CITY:SANTA ROSASTATE: CAZIP CODE:
95404
CAPACITY:6CENSUS: 6DATE:
10/30/2025
UNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Arlinda Gregorio, AdministratorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility has rodents
INVESTIGATION FINDINGS:
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At approximately 11:50 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to deliver Complaint findings regarding the above allegation and met with facility Administrator Arlinda Gregorio.

During the course of the investigation LPAs Frank and Nakagawa conducted multiple facility visits, conducted interviews, collected and reviewed documents.

Complaint alleges the facility has rodents. The facility is located in a residential neighborhood. The facility has a large, open backyard area. On LPAs’ inspections on 8/20/2025 and 9/18/2025 LPAs observed a large number of boxes and containers in the open backyard patio area. These boxes and containers could offer a potential nesting area for rodents. The owner of the property has an existing service agreement with Terminix, which is a professional pest prevention and elimination company.

Continued on 9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 21-AS-20250819170640
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: BURBANK MANOR
FACILITY NUMBER: 496803071
VISIT DATE: 10/30/2025
NARRATIVE
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...Continued from LIC 9099

During Terminix’s 7/1/2025 service visit the inspection notes that there was no exterior rodent or wildlife evidence found. During a requested service call on 8/7/2025 the Terminix inspection documents note no rodent activity, but the facility was treated for fire ants. During a service call on 8/11/2025 the Terminix inspection notes state that rodent traps were placed around the facility as there was some evidence of rodent activity found. During a service call on 9/9/2025 the Terminix inspection notes state that rodent traps were reset in a crawlspace and that nothing was caught. In a letter dated 10/8/2025 the facility licensee stated that the back porch area has been cleared of all boxes and containers. LPA confirmed that the back porch area has been cleared of all boxes and containers. So, 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.

Exit interview conducted. Copy of LIC-9099 and LIC-9099-C discussed and provided to Administrator Gregorio. Signature on form confirms receipt of documents.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 21-AS-20250819170640
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: BURBANK MANOR
FACILITY NUMBER: 496803071
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/20/2025
Section Cited
CCR
87213
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87213 Finances The licensee shall have a financial plan..., Application for License, and that assures sufficient resources...for care of residents;... and shall submit such financial reports as may be required upon the written request of the licensing agency. This requirement is not met as evidenced by:
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Licensee to submit an LIC 9098 Proof of Correction stating that the facility's rent will be paid on time per the lease agreement in the future. Licensee will also submit financial records requested by Community Care Licensing by the POC due date of 11/20/2025.
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Based on observation & interviews, the licensee did not comply with the section cited above in that the facility's rent was not paid on time per the lease agreement for three (3) months which poses a potential health, safety or personal rights risk to persons in care.
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Type B
11/20/2025
Section Cited
CCR
87202(a)
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87202 Fire Clearance (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal...This requirement is not met as evidenced by:
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Licensee to submit an LIC 9098 Proof of Correction stating that the shed in the back of the facility will only be used for storage and will not be used for sleeping or a break area to Community Care Licensing by the POC due date of 11/20/2025.
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Based on observation & interviews, the licensee did not comply with the section cited above in the shed at the back of the facility was being used for occupancy which poses a potential health, safety or personal rights risk to persons 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: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5