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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 216803891
Report Date: 09/11/2026
Date Signed: 09/11/2026 02:40:04 PM

Unsubstantiated


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
09/02/2026 and conducted by Evaluator Robert Frank
COMPLAINT CONTROL NUMBER: 21-AS-20260902090913
FACILITY NAME:MARIN TERRACEFACILITY NUMBER:
216803891
ADMINISTRATOR:KATHLEEN DEVERAFACILITY TYPE:
740
ADDRESS:297 Miller AveTELEPHONE:
(925) 577-3755
CITY:Mill ValleySTATE: CAZIP CODE:
949412832
CAPACITY:49CENSUS: 28DATE:
09/11/2026
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Kathleen Devera, AdministratorTIME COMPLETED:
02:50 PM
ALLEGATION(S):
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Facility’s signal system is in disrepair
INVESTIGATION FINDINGS:
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At approximately 10:45 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to initiate and deliver findings for a Complaint Investigation regarding the above allegation and met with facility Administrator Kathleen Devera.

During the course of the investigation LPA conducted a facility visit, conducted interviews, collected and reviewed documents.

Complaint alleges that the facility’s call system is in disrepair. Witness W1 stated that the call system has had functioning issues numerous times over the past two (2) years. W1 stated that the system would break down, it would get fixed and then break down again. Facility Administrator Kathleen Devera stated that on 7/30/2026 their call system began to have errors.

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

DATE: 09/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2026
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-20260902090913
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: MARIN TERRACE
FACILITY NUMBER: 216803891
VISIT DATE: 09/11/2026
NARRATIVE
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...Continued from 9099

Administrator Devera contacted the call system manufacturer’s support desk on 7/30/2026 and they were able to reset the system on the same day. Administrator Devera stated that on 8/31/2026 the system began to error again. Administrator Devera contacted the call system manufacturer’s support desk on 8/31/2026 and they were able to reset the system on the same day. On the following day, 9/1/2026 the system began to error again. Administrator Devera decided to change the computer used to monitor the call system. Administrator Devera stated that there have been no further errors since they changed the computer used to monitor the call system. LPA interviewed three (3) residents. The residents report that except for the days noted above there have been no other issues with the call system. Facility staff stated that except for the days noted above the system has been working normally since it’s installation approximately two (2) years ago. During today’s visit LPA tested the facility call system numerous times from different locations within the facility including the annex building. In all instances the call system functioned normally and in all instances, staff responded to the call. LPA audited the facility call log for the time frame of 9/1/2026 through 9/5/2026. During that time there were one hundred thirty-six (136) calls for assistance on the facility call system. Of those calls there was one (1) call with a 7.2-minute response time. There were three (3) calls with the response time being between two (2) and five (5) minutes. The remaining one hundred thirty-two (132) calls were responded to in under two (2) minutes with the vast majority of the calls being responded to in under one (1) minute. LPA was unable to find evidence of continual instances of the facility’s call system being in disrepair. 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.

No deficiencies cited during today's visit.

Exit interview conducted. Copy of LIC-9099, LIC-9099C discussed and provided to Administrator Devera. Signature on form confirms receipt of documents.

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

DATE: 09/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2