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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 176804346
Report Date: 05/19/2026
Date Signed: 05/19/2026 04:40:27 PM

Substantiated


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
05/03/2026 and conducted by Evaluator Julie Florio
COMPLAINT CONTROL NUMBER: 21-AS-20260503123731
FACILITY NAME:ORCHARD PARK AL AND MEMORY CAREFACILITY NUMBER:
176804346
ADMINISTRATOR:JONES, MELISSAFACILITY TYPE:
740
ADDRESS:14789 BURNS VALLEY ROADTELEPHONE:
(707) 995-1900
CITY:CLEARLAKESTATE: CAZIP CODE:
95422
CAPACITY:60CENSUS: 32DATE:
05/19/2026
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Kirendeep Bhade, Executive DirectorTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff does not ensure activities are provided to residents.
INVESTIGATION FINDINGS:
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On 05/19/2026, at approximately 12:45 PM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a subsequent complaint investigation and deliver complaint findings for Complaint Report #21-AS-20260503123731, which was received by Community Care Licensing (CCL) on 05/03/2026. LPA met with Kirendeep Bhade, Executive Director. Complainant alleges that staff does not ensure activities are provided to residents.

On 05/07/2026, LPA initiated this complaint investigation and obtained documents, made observations, and conducted interviews. Based on staff schedules obtained for 04/2026 and 05/2026, staff observed on site during the visit, and interviews conducted with Staff 1 (S1), Staff 2 (S2), and Resident 1 (R1), the facility does not currently have one fulltime staff member who has the "full-time responsibility to organize, conduct and evaluate planned activities," nor is there "staff assistance as necessary in order for all residents to participate in accordance with their interests and abilities," as required per regulation.

Continued on LIC9099C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2026
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 3
Control Number 21-AS-20260503123731
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: ORCHARD PARK AL AND MEMORY CARE
FACILITY NUMBER: 176804346
VISIT DATE: 05/19/2026
NARRATIVE
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Continued from LIC9099...

Further, these interviews revealed that Staff 3 (S3) had been working in hybrid role as the activities coordinator and the bus driver two days per week until going out on leave several weeks ago, rather than in a designated activities director role as required for a facility approved for a capacity of 50 or more residents. Per interviews, facility staff have been filling in until either S3 returns or the position is filled. These interviews also revealed that activities do not occur according to the schedule either due to the coordinator driving the bus, supplies not present for the scheduled activity, or the coordinator being our on leave. Additionally, LPA's interviews revealed that monthly outings to the store, the local casino, and other routine excursions have not been occurring, nor has the facility facilitated holidays such as a mother's day celebration or other smaller holidays, such as Cinco De Mayo which have all previously been celebrated at the facility.

Based on documents obtained and interviews conducted, the allegation that staff does not ensure activities are provided to residents is SUBSTANTIATED. A finding that a complaint allegation is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

Deficiency is cited from Title 22 Regulations, Division 6, (see LIC9099D).

Exit interview conducted with Executive Director, whose signature on form confirms receipt of documents. Copy of report and appeal rights provided to Executive Director.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 21-AS-20260503123731
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: ORCHARD PARK AL AND MEMORY CARE
FACILITY NUMBER: 176804346
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/19/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/19/2026
Section Cited
CCR
87219(f)
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Planned Activities 87219(f) In facilities licensed for fifty (50) persons or more, one staff member shall have full-time responsibility to organize, conduct and evaluate planned activities, and shall be given such staff assistance as necessary in order for all residents to participate in...
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Licensee did not ensure that activities are provided to residents as required per regulation. This poses a potential Health, Safety and/or Personal Rights risk to residents in care.

Licensee to submit a self certification that
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accordance with their interests and abilities. The program of activities shall be written, planned in advance, kept up-to-date, and made available to all residents.
This requirement is not met as evidenced by:
Based on observations made, records reviewed, and interviews conducted,
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they have reviewed the regualtion and understand the requirement to have a designated fulltime activities coodinator in a facility this size and to submit a written plan of how the facility will meet this requirement moving forward to CCLD by POC due date of 06/19/2026.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3