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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 576804194
Report Date: 05/13/2025
Date Signed: 05/13/2025 01:28:02 PM

Unsubstantiated


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
05/09/2025 and conducted by Evaluator Jill Nakagawa
COMPLAINT CONTROL NUMBER: 21-AS-20250509091140
FACILITY NAME:WOODLAND GARDENS SENIOR LIVINGFACILITY NUMBER:
576804194
ADMINISTRATOR:PAZ, DIANAFACILITY TYPE:
740
ADDRESS:240 PALM AVETELEPHONE:
(530) 661-0574
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY:100CENSUS: 65DATE:
05/13/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Diana Paz, AdministratorTIME COMPLETED:
12:45 PM
ALLEGATION(S):
1
2
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9
Staff did not provide resident with appropriate sleeping accommodations.
Staff denied resident visitors while in care.
INVESTIGATION FINDINGS:
1
2
3
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5
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9
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On 05/13/2025, Licensing Program Analyst (LPA) Nakagawa arrived unannounced to conduct a visit for the purpose of initiating a complaint and delivering complaint findings regarding the above allegations. LPA met with Administrator Diana Paz. LPA made observations, conducted interviews and reviewed documents.
The complaint alleges that Staff did not provide resident with appropriate sleeping accommodations. The reporting party stated that resident (R1) was left to sleep in chair for 2 months. LPA conducted an inspection and found that the room of R1 has a lounge chair and a hospital bed. Staff report that R1 does use the chair but staff assist R1 to bed each night. Therefore the allegation that Staff do not provide resident with appropriate sleeping accommodations is unsubstantiated.
Continued on 9099-C....

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025
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-20250509091140
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: WOODLAND GARDENS SENIOR LIVING
FACILITY NUMBER: 576804194
VISIT DATE: 05/13/2025
NARRATIVE
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Continued from 9099....

*****This Report has been Amended*****

The complaint alleges that Staff denied resident visitors while in care. The reporting party stated that I1 and I2 have been denied visitation. LPA conducted interview with S1 and S2 who stated that no residents have been denied visitors except for individuals (I1) who had a court order against their visitation and there is no evidence to corroborate that I2 was ever denied visitation. Therefore the allegation that Staff denied resident visitors while in care is Unsubstantiated.

Although the allegation(s) 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.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2