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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486804191
Report Date: 09/04/2026
Date Signed: 09/04/2026 02:57:27 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
06/11/2026 and conducted by Evaluator Jill Nakagawa
COMPLAINT CONTROL NUMBER: 21-AS-20260611094620
FACILITY NAME:FARMSTEAD AT DIXON, THEFACILITY NUMBER:
486804191
ADMINISTRATOR:MARK REYESFACILITY TYPE:
740
ADDRESS:350 GATEWAY DRIVETELEPHONE:
(707) 676-5060
CITY:DIXONSTATE: CAZIP CODE:
95620
CAPACITY:96CENSUS: 85DATE:
09/04/2026
UNANNOUNCEDTIME BEGAN:
12:58 PM
MET WITH:Mark Reyes, AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Resident sustained an injury while in care.
INVESTIGATION FINDINGS:
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On 9/04/2026 Licensing Program Analyst (LPA) Nakagawa arrived unannounced to conduct a complaint investigation regarding the above allegation. LPA met with Administrator Mark Reyes to discuss.
The complaint alleges that a resident sustained injury while in care. The complainant states emergency personnel were escorted to resident (R1’s) room by facility staff and found R1 sitting upright on the bathroom floor with visual injuries to their left hand. Emergency personnel were concerned due to observing behaviors of Caregiver helping R1 being verbally hostile toward another staff member and the behavior of R1 with S1 present. LPA Nakagawa reviewed records for R1. On 6/11/2026 caregiver S1 stated that R1 was found in the bathroom with a cut on hand, apparently from hitting it on the wheelchair that was being stored in the bathroom. LPA spoke with R1 who stated that staff are kind to R1and no one is mean. LPA reviewed personnel records of S1 and there were no write-ups or reports regarding the behavior of S1 towards staff or residents. LPA also reviewed phone messages between the Resident Care Coordinator and staff S1 and other staff and there were no issues reported.
(Continued on 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2026
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-20260611094620
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: FARMSTEAD AT DIXON, THE
FACILITY NUMBER: 486804191
VISIT DATE: 09/04/2026
NARRATIVE
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(Continued from 9099)

Based on the statements of individuals interviewed, the personnel records of S1 and the medical records of R1, the allegation that Resident sustained an injury while in care is unsubstantiated. Although the allegation 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: 09/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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