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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496803860
Report Date: 06/15/2026
Date Signed: 06/15/2026 12:09:48 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
06/09/2026 and conducted by Evaluator Dina Alviso
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20260609125941
FACILITY NAME:CLEARWATER AT SONOMA HILLSFACILITY NUMBER:
496803860
ADMINISTRATOR:HOMER, JAMESFACILITY TYPE:
740
ADDRESS:710 ROHNERT PARK EXPRESSWAY ETELEPHONE:
(707) 710-7385
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY:114CENSUS: 89DATE:
06/15/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:James Homer-AdministratorTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Administration staff did not provide resident with full written disclosure of preadmission fee charges and refund conditions
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alviso conducted a complaint inspection, on 6/15/26 at approximately 9:00am, and met with Administrator/Executive Director James Homer.

Reporting party alleges "administration staff did not provide resident with full written disclosure of preadmission fee charges and refund conditions".

LPA reviewed resident (R1) records regarding preadmission fees paid prior to moving into the facility. Resident was assessed by facility staff for appropriate care needs/services, but the resident/responsible party decided to not admit the resident into care. Responsible party (RP) requested a refund on 5/18/26 of preadmission fees paid on 5/8/26 in the amount of $8455.00; Facility notified RP that it would take approximately 30 days for the refund.

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

DATE: 06/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2026
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 4
Control Number 21-AS-20260609125941
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: CLEARWATER AT SONOMA HILLS
FACILITY NUMBER: 496803860
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/15/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/15/2026
Section Cited
CCR
87507(g)(3)(C)(1)
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87507(g)(3)(C)(1) Admission Agreements- Any fee that is charged prior to or after admission, shall be clearly specified. If a licensee charges a preadmission fee, the licensee must provide the applicant or his or her representative with a written general statement describing all costs associated with the preadmission fee charges and stating that the preadmission fee is refundable, and describing conditions for the refund. This requirement was not met as evidenced by:
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Licensee/Administrator to ensure preadmission fees obtained from residents/potential residents , that there has been provided a written general statement describing all costs associated with the preadmission fee charges and stating that the preadmission fee is refundable, and describing conditions for the refund, as required.
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Per review of records obtained from the facility, there was no record of facility providing RP, when RP paid the $8455.00, a required written general statement describing all costs associated with the preadmission fee charges and stating that the preadmission fee is refundable, and describing conditions for the refund. This is a risk to residents personal rights.
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Please submit how the facility will ensure compliance with this regulation regarding preadmission fees/charges as required,
POC due 7/15/26.
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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: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 21-AS-20260609125941
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: CLEARWATER AT SONOMA HILLS
FACILITY NUMBER: 496803860
VISIT DATE: 06/15/2026
NARRATIVE
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Per review of records obtained from the facility, there was no record of facility providing RP, when RP paid the $8455.00, a required written general statement describing all costs associated with the preadmission fee charges and stating that the preadmission fee is refundable, and describing conditions for the refund.

Per investigation the above allegation is substantiated. Deficiency will be cited, 87507(g)(3)(C)(1) Admission Agreements- Any fee that is charged prior to or after admission, shall be clearly specified. If a licensee charges a preadmission fee, the licensee must provide the applicant or his or her representative with a written general statement describing all costs associated with the preadmission fee charges and stating that he preadmission fee is refundable, and describing conditions for the refund, see LIC9099D.

The preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is being cited.
Failure to correct deficiencies by due dates, may result in additional deficiency citations and/or civil penalties being assessed.

Exit interview conducted with the Administrator James Homer.
Appeal Rights provided to the Administrator.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
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
06/09/2026 and conducted by Evaluator Dina Alviso
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20260609125941

FACILITY NAME:CLEARWATER AT SONOMA HILLSFACILITY NUMBER:
496803860
ADMINISTRATOR:HOMER, JAMESFACILITY TYPE:
740
ADDRESS:710 ROHNERT PARK EXPRESSWAY ETELEPHONE:
(707) 710-7385
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY:114CENSUS: DATE:
06/15/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:James Homer-AdministratorTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Administration staff are not providng resident with a refund
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alviso conducted a complaint inspection, on 6/15/26 at approximately 9:00am, and met with Administrator/Executive Director James Homer.
Reporting party (RP) alleges "administration staff are not providng resident with a refund". LPA reviewed resident (R1) records regarding preadmission fees paid prior to moving into the facility. Per review of facility records obtained, responsible party (RP) requested a refund on 5/18/26 of preadmission fees paid on 5/8/26 in the amount of $8455.00; Facility notified RP that it would take approximately 30 days for the refund. Facility had not yet paid the due refund when it was identified that the RP had filed a dispute with their credit card bank/company regarding the preadmission fee of $8455. This dispute was granted by RP's credit card company, and the full amount was cancelled/returned to the bank. There is no refund due to the prospective resident/responsible party due to their filing the credit card dispute on their end, and it aving been approved. Based on the interviews, record/document reviews, and related information obtained during the investigation, the allegation is Unsubstantiated, meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.
No deficiencies cited. Exit interview was conducted with the Executive Director James Homer.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2026
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 1