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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 04:38:01 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
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 provide adequate supervision to residents due to lack of staff.
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 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 provide adequate supervision to residents due to lack of staff.

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 and staff observed on site during the visit, the facility meets and/or exceeds the minimum required staffing of at least one awake staff member in each unit on all shifts.

Continued on LIC9099C...
Unsubstantiated
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 2
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...

During this visit, interviews with Staff 1 (S1) and Staff 2 (S2) and obtained proof of job postings revealed that although the facility meets the minimum staffing requirements per regulation, management is activity working on hiring additional staff for various roles throughout the facility, to include having two direct care staff in each unit on each shift as well as one medication technician on each shift to ensure resident's' care needs are being met. Additionally, these interviews and an interview conducted with Resident 1 (R1) did not reveal that any adverse events have occurred as the result of the current staff to resident ratios. Based on interviews conducted, observations made, and documents obtained, LPA received conflicting information.

Based on interviews conducted, observations made, and records obtained, the allegations that staff does not provide adequate supervision to residents due to lack of staff is UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that 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.

No deficiencies cited.

Exit interview conducted with Executive Director, whose signature on form confirms receipt of documents.
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 2