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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496804279
Report Date: 10/22/2025
Date Signed: 10/22/2025 03:44:39 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
09/23/2025 and conducted by Evaluator Christi Coppo
COMPLAINT CONTROL NUMBER: 21-AS-20250923110324
FACILITY NAME:ELSA CARE HOMEFACILITY NUMBER:
496804279
ADMINISTRATOR:WAINAINA, KENNEDYFACILITY TYPE:
740
ADDRESS:10 CREEKVIEW COURTTELEPHONE:
(707) 539-5625
CITY:SANTA ROSASTATE: CAZIP CODE:
95409
CAPACITY:6CENSUS: 5DATE:
10/22/2025
UNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Kennedy Wainaina, AdministratorTIME COMPLETED:
03:59 PM
ALLEGATION(S):
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Staff member does not adequately supervise resident in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christi Coppo arrived at this facility unannounced, to deliver findings on the above allegations. LPA met with Administrator Kennedy Wainaina.

Complaint alleges staff member does not adequately supervise resident in care. Resident (R2) has recently started attending a day program. The program has a hand-to-hand escort policy. This policy requires that all participants are escorted in and their escort must wait while the participant’s temperature is taken and the participant has a quick assessment to establish they are presenting as well enough to attend that day’s program. This policy is communicated verbally and through email. LPA confirmed that email notifying staff of the policy was provided to the facility staff responsible for the transport of R2 to the day program. Evidence obtained during investigation indicates that the staff transporting R2 was not following the hand-to-hand escort policy; instead the staff would drop off R2, without escorting them into the

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

DATE: 10/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2025
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 4
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
09/23/2025 and conducted by Evaluator Christi Coppo
COMPLAINT CONTROL NUMBER: 21-AS-20250923110324

FACILITY NAME:ELSA CARE HOMEFACILITY NUMBER:
496804279
ADMINISTRATOR:WAINAINA, KENNEDYFACILITY TYPE:
740
ADDRESS:10 CREEKVIEW COURTTELEPHONE:
(707) 539-5625
CITY:SANTA ROSASTATE: CAZIP CODE:
95409
CAPACITY:6CENSUS: 5DATE:
10/22/2025
UNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Kennedy Wainaina, AdministratorTIME COMPLETED:
03:59 PM
ALLEGATION(S):
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9
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. LPA met with Administrator Kennedy Wainaina

Complaint alleges personal rights violation. Complainant states that staff yell at and intimidate R2 and that R2 indicated that they are forced to leave the facility during the daytime hours. During investigation, LPA received conflicting accounts of staff yelling at R2. During investigation, LPA conducted interview with R2. R2 indicated to LPA that staff do not force them to go to day program and that they like going. 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. .
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2025
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 4
Control Number 21-AS-20250923110324
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: ELSA CARE HOME
FACILITY NUMBER: 496804279
VISIT DATE: 10/22/2025
NARRATIVE
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Continued from 9099...

building, and would drive off before R2 had their temperature taken resulting in at least one instance where the staff had to return to the program and pick up resident because they had a high temperature. Witness reports that staff was also not following the hand-to-hand escort practice when picking up R2 from the program. LPA’s review of R2’s physician report indicated that R2 cannot leave the facility unassisted. LPA‘s review of R2’s care plan indicated that R2 requires support and guidance in organizing tasks such as public transportation. Staff did not ensure adequate supervision of R2 by not following the hand-to-hand escort policy. Based on LPA’s interviews and record review, 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.

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator and a copy of this report was given.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 21-AS-20250923110324
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: ELSA CARE HOME
FACILITY NUMBER: 496804279
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/24/2025
Section Cited
CCR
87468.2(a)(4)
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Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in care...shall have all of the following personal rights:(4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.
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Staff will utlize drop off and pick up sign-in sheet every day during dropping off and picking up resident from day program. Staff will provide signature of drop off and pick up showing that they are escorting the resident in and out of the day program facility.
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This requirement was not met by licensee as evidenced by: staff did not adequately supervise R2, which poses an potential health, safety, and/or personal rights risk to resident in care.
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Facility will submit logs from time period of 10/27/25 through 12/1/25. Facility will send plan to submit logs by plan of correction due date. Logs due to CCL on 12/5/25
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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: 10/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2025
LIC9099 (FAS) - (06/04)
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