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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496804250
Report Date: 11/20/2025
Date Signed: 11/20/2025 03:55:25 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
09/30/2025 and conducted by Evaluator Christi Coppo
COMPLAINT CONTROL NUMBER: 21-AS-20250930125229
FACILITY NAME:GRAND CRU SENIOR CARE CORPFACILITY NUMBER:
496804250
ADMINISTRATOR:SEKHON, TEJPALFACILITY TYPE:
740
ADDRESS:2540 SUMMERFIELD RDTELEPHONE:
(707) 843-5629
CITY:SANTA ROSASTATE: CAZIP CODE:
95405
CAPACITY:6CENSUS: DATE:
11/20/2025
UNANNOUNCEDTIME BEGAN:
02:04 PM
MET WITH:Tejpal Sekhon, licenseeTIME COMPLETED:
04:10 PM
ALLEGATION(S):
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Licensee refused to allow resident to have visitor
Personal Rights
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christi Coppo arrived at this facility unannounced to deliver findings on the above allegations and was greeted by caregiver. LPA spoke to licensee Tejpal Sekon via telephone to advise LPA was here to deliver findings. Licensee arrived later.

Complaint alleges licensee refused to allow resident (R1) to have visitor. On 9/23/25, licensee was informed that R1 had exposure to COVID due to exposure from Individual (I1) whom just tested positive for COVID. On 9/24/25 resident (R1) tested positive for COVID, but per licensee R1 did not exhibit any symptoms. On 9/29/25 I1 tried to visit R1 but was denied entry to the facility and access to R1. During investigation, evidence obtained shows that licensee required that I1 prove that they were testing negative for COVID before they would be allowed to visit R1.

Complaint alleges personal rights violations of R1. On 9/24/25, licensee isolated R1 in their room for

Continued on 9099C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
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-20250930125229
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: GRAND CRU SENIOR CARE CORP
FACILITY NUMBER: 496804250
VISIT DATE: 11/20/2025
NARRATIVE
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Continued from 9099...

COVID quarantine. Per licensee, R1 was agitated and fought with the staff to be let out of their room. However, R1’s attempts were unsuccessful and R1 remained confined to their room until at least 9/30/25. During investigation, LPA interviewed staff. Staff report that R1 was isolated to their room between 1-2 weeks. Additionally, complaint alleges violation of personal rights of R1 in that during isolation, R1 was not provided any activities. R1 did not have a TV in their room. Licensee put a TV in R1’s room the 2nd day of isolation. However, the TV only played a screensaver of a fishbowl. During investigation, LPA confirmed through observation that the TV only displayed a fishbowl screensaver. LPA was informed that TV did not work other than the screensaver and that remote was not available or lost. During investigation, LPA made observations of R1’s room. Room did not contain any materials that could be considered an activity such as a book, magazine, word search, tablet, crayons, crafts, or DVD player. Aside from a few photographs on the wall R1 had nothing else in the room except a bed, chair, and lamp. LPA did not observe anything in the form of entertainment or stimuli located in R1’s room.

LPA confirmed through interviews that the facility was not having an outbreak of COVID and the R1 was the only resident who had tested positive for COVID. The Department of Public Health did not and does not have any requirement for the limitation of visitation. Additionally, the State of California is not in a state of emergency pertaining to COVID. On 3/11/24, CCL sent out PIN 24-01-ASC which superseded PIN 23-13-ASC issued 6/15/23. PIN 23-13-ASC indicated the latest guidance on isolation and testing, visitation, and infection control requirements including masking guidance and the removal of quarantine recommendations for persons in care and staff pertaining to COVID. However, per the California Department of Public Health, as of 1/9/24, this guidance is for historical purposes only. Therefore, there are no regulatory requirements in place requiring isolation or denial of visitation by those that have tested positive for COVID. So, the licensee cannot of their own volition choose to limit visitation by I1 to the facility to visit with R1. So, based on LPA’s interviews and observation, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 Chapter 8, are being cited on the attached 9099D.

Continued on 9099C(2)...

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SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 21-AS-20250930125229
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: GRAND CRU SENIOR CARE CORP
FACILITY NUMBER: 496804250
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/04/2025
Section Cited
CCR
87468.2(a)(21)
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1...residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:(21) To consent to have their relatives
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Facility to self-certify that they will observe the personal rights of all residents at all times, including having and choosing visitors by plan of correction due date.
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and other individuals of their choosing visit during reasonable hours, privately, and without prior notice. This requriement not met by licensee as evidenced by: R1 was denied access to I1, which poses an potential health, safety, and/or personal rights risk to resident in care.
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Type B
12/04/2025
Section Cited
CCR
87219(a)(3)
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87219 Planned Activities (a) Residents shall be encouraged to maintain and develop their quality of life through participation in a variety of planned activities. The activities made available shall include: (3) Cognitive and mental stimulation activities such as reading, writing, movies, crossword puzzles, board
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Facility to research and implement activties designed specifically to meet the needs of the residents and their cognitve functioning by plan of correction due date. Licensee to send LPA a list of identified activities of at least 5-10 items and implement them by no later than 12/15/25
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and card games, and using the computer. This requirement not met by licensee as evidenced by: R1 was isolated to their room without any activities or anything that would help aid in cognitive stimulation, which poses an potential health, safety, and/or personal rights risk to resident 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: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 21-AS-20250930125229
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: GRAND CRU SENIOR CARE CORP
FACILITY NUMBER: 496804250
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/27/2025
Section Cited
CCR
87468.2(a)(4)
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1...residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet
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Licensee will add a personal rights poster in facility to make personal rights more visible and in the mind of staff. Licensee to self-certify that they will at all times provide and instruct staff to meet the needs of residents, including providing appropriate activites designed to meet
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their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement not met by licensee as evidenced by: R1 was isolated to their room without any activities or anything that would help aid in cognitive stimulation, which poses an potential health, safety, and/or personal rights risk to resident in care.
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their level of cognitive functioning.
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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: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 21-AS-20250930125229
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: GRAND CRU SENIOR CARE CORP
FACILITY NUMBER: 496804250
VISIT DATE: 11/20/2025
NARRATIVE
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Continued from 9099C...


Exit interview conducted with licensee and appeal rights given.

Note** LPA and Admin discussed concerns regarding COVID safety precautions. Licensee expressed that he is concerned above all things about the safety and health of his staff and residents. Licensee recognizes that the state of California is not in an emergency state pertaining to COVID. However, in order to ensure the safety and health of all residents and staff licensee will provide an addendum to the House Rules stating that any visitors that are identified as being positive for COVID will be allowed to enter the facility but will be required to wear a mask during visitation.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5