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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496803282
Report Date: 09/16/2026
Date Signed: 09/16/2026 03:21:43 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
07/24/2026 and conducted by Evaluator Christi Coppo
COMPLAINT CONTROL NUMBER: 21-AS-20260724144114
FACILITY NAME:SPRING CREEK LODGEFACILITY NUMBER:
496803282
ADMINISTRATOR:ALCONES, LILYFACILITY TYPE:
740
ADDRESS:3650 SPRING CREEK DRIVETELEPHONE:
(707) 523-3255
CITY:SANTA ROSASTATE: CAZIP CODE:
95405
CAPACITY:6CENSUS: DATE:
09/16/2026
UNANNOUNCEDTIME BEGAN:
02:34 PM
MET WITH:TIME COMPLETED:
03:36 PM
ALLEGATION(S):
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Staff did not provide adequate supervision resulting in resident sustaining injuries.
Staff did not respond to resident's call button in a timely manner.
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 caregiver. Licensee Lily Alcones was available by phone and gave caregiver permission to sign report.

Complaint alleges staff did not provide adequate supervision resulting in resident sustaining injuries and staff did not respond to resident's call button in a timely manner. Complainant states that resident (R1) attempted to reach their suctioning cup from their bed, but was unable to do so. Complainant states that R1 rang the bell provided to alert staff; however, no one responded for approximately 15–20 minutes. R1 then allegedly crawled out of bed and fell, sustaining multiple skin tears in the process. Complainant states facility staff were present but did not respond quickly enough.

During investigation LPA conducted interviews. Three (3) out of three (3) witnesses report that the

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

DATE: 09/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2026
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-20260724144114
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: SPRING CREEK LODGE
FACILITY NUMBER: 496803282
VISIT DATE: 09/16/2026
NARRATIVE
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Continued from 9099...

incident in question happened on the first day of R1’s residency at the facility. R1 was present at the facility for approximately one (1) hour before incident occurred. Three (3) out of three (3) witnesses report that facility staff were in R1’s room with a hospice nurse getting R1 set up with their room supplies and providing them a bell to call staff when needed. R1 subsequently had an evaluation by the hospice nurse. R1 then asked to speak to the hospice nurse privately. After speaking privately to R1, hospice nurse left R1’s room and went to facility kitchen to speak to facility staff. According to witness accounts, R1 was alone in their room for no more than 4-5 minutes. When hospice nurse went back into R1’s room that is when R1 was observed to be on the floor and bleeding from their elbows and knees. Three (3) out of three (3) witnesses report never hearing a call for help, any ringing of the bell, or any thud or loud noise coming from R1’s room. During investigation, LPA verified that bell can be heard from R1’s room from the kitchen. 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.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2