126803492-2-2-2022-21-AS-BMOS-CBYUJ3-20220225143649

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 126803492
Report Date: 02/02/2022
Date Signed: 02/02/2022 02:57:10 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
12/23/2021 and conducted by Evaluator Christopher Arnhold

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20211223130608

FACILITY NAME:	CLEO'S HOME		FACILITY NUMBER:	126803492
ADMINISTRATOR:	HANRAHAN-GEE, LEAH		FACILITY TYPE:	740
ADDRESS:	129 HIGGINS STREET		TELEPHONE:	(707) 382-2697
CITY:	EUREKA	STATE: CA	ZIP CODE:	95501
CAPACITY:	15	CENSUS: 13	DATE:	02/02/2022
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Shadie Fitzgerald		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff used actions of punitive nature towards resident in care

INVESTIGATION FINDINGS:

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At approximately 2:15PM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to deliver investigation findings for the the above allegation. LPA met with Program Director Shadie Fitzgerald. During the course of this investigation, LPA interviewed staff and residents regarding the above allegation. Based on interviews conducted, there were no incidents where staff acted with a punitive nature towards a client. LPA attempted to interview the resident that was allegedly involved, but they refused to speak with LPA.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is Unsubstantiated.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher Arnhold	TELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

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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