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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496803825
Report Date: 09/15/2026
Date Signed: 09/15/2026 12:47:36 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
07/08/2026 and conducted by Evaluator Robert Frank
COMPLAINT CONTROL NUMBER: 21-AS-20260708152015
FACILITY NAME:VINE RIDGE SENIOR LIVINGFACILITY NUMBER:
496803825
ADMINISTRATOR:LUA, CARLAFACILITY TYPE:
740
ADDRESS:247 TREADWAY DRIVETELEPHONE:
(707) 791-4787
CITY:CLOVERDALESTATE: CAZIP CODE:
95425
CAPACITY:99CENSUS: 42DATE:
09/15/2026
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Alexis Short, Resident Care CoordinatorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Facility Staff is Yelling at Residents
INVESTIGATION FINDINGS:
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At approximately 9:05 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to deliver Complaint findings regarding the above allegation and met with Resident Care Coordinator (RCC) Alexis Short.

During the course of the investigation LPA conducted multiple facility visits, conducted interviews, collected and reviewed documents. Complaint alleges that facility staff yell at residents. Witness W1 stated that on 7/8/2026 at approximately 9:00 AM, staff member S1 had yelled at a resident. According to witness and staff interviews resident R1 was expressing frustration to staff member S3 regarding their morning medication administration. Staff member S1 overheard S3 discussing R1’s frustrations with S2. At that point staff members S1, S2 & S3 went to discuss the matter with R1. Witness 1 stated that at this point S1 yelled at R1. When asked if facility staff have ever yelled at them R1 stated, “No, no one has ever yelled at me.”

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

DATE: 09/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2026
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-20260708152015
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: VINE RIDGE SENIOR LIVING
FACILITY NUMBER: 496803825
VISIT DATE: 09/15/2026
NARRATIVE
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...Continued from 9099

When asked how the facility staff treat them R1 stated, “They treat me fine. We have had some disagreements about what time medications are given to me, but the staff are following the doctor’s orders.” Staff member S3 stated that staff member S1 didn’t yell during the exchange with R1. S3 further stated that both S1 and R1 were instead speaking with “raised voices.” During an interview when asked if they ever yelled at residents, S1 stated, “I have never yelled at any resident”. On 7/9/2026, the facility filed an LIC 624 Unusual Incident/Injury Report (IR) regarding the exchange per regulation. 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 report discussed and provided to RCC Short. Signature on form confirms receipt of documents.

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

DATE: 09/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2