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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201175
Report Date: 12/13/2023
Date Signed: 01/08/2024 10:55:41 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/04/2023 and conducted by Evaluator Jill Clancy-Czuleger
COMPLAINT CONTROL NUMBER: 15-AS-20231204121737
FACILITY NAME:WINDERMERE AT WHITMANFACILITY NUMBER:
079201175
ADMINISTRATOR:WARD, WHITNEYFACILITY TYPE:
740
ADDRESS:1921 WHITMAN RD.TELEPHONE:
(415) 710-5169
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY:6CENSUS: 4DATE:
12/13/2023
UNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Cydel Caplo, StaffTIME COMPLETED:
10:15 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility mailbox is in disrepair.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/13/2023 at approximately 9:25 am Licensing Program Analyst (LPA) J. Clancy-Czuleger arrived unannounced to conduct a complaint visit. LPA met with caregiver Cydel Caplo and explained the purpose of the visit. Administrator Matt Ward was called and designated Cydel Caplo to sign off on the report.

During the course of the investigation, LPA J. Clancy-Czuleger interviewed Administrator and staff about the mailbox. Staff 1 (S1) stated that the city has been doing months of repairs on the street and knocked the mailbox over in the process. They decided to hold off on replacing the mailbox until the city was done with the street work as to avoid it getting knocked over again. On December 10, 2023, the facility replaced the mailbox.

We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. Therefore, this allegation is unfounded.
Exit Interview conducted and a copy of this report provided.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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