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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 210108757
Report Date: 02/24/2022
Date Signed: 02/24/2022 01:45:34 PM

Unsubstantiated


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
12/20/2021 and conducted by Evaluator Farhaan Sarangi
COMPLAINT CONTROL NUMBER: 21-AS-20211220092102
FACILITY NAME:AVANTIFACILITY NUMBER:
210108757
ADMINISTRATOR:BECO, MICHAELFACILITY TYPE:
735
ADDRESS:7 LE CLAIRE COURTTELEPHONE:
(415) 472-2875
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY:8CENSUS: 8DATE:
02/24/2022
UNANNOUNCEDTIME BEGAN:
01:30 AM
MET WITH:Mental Health Counselor, Steve PozziTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff threatens resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Sarangi arrived at Avanti unannounced to deliver complaint findings. LPA was met at the door by Mental Health Counselor, Steve Pozzi and was granted access into the facility.

During the complaint investigation, LPA interviewed staff, residents, and various outside parties. LPA toured the facility on December 28, 2021. In addition, LPA reviewed Client records.

The complaint alleges that staff threatened resident. LPA interviewed identified staff members, various outside parties and all clients in care. Based on the interviews that were conducted and the information received, there is no evidence to support that any staff member threatened any of the clients in care.

Based on the statements received, observations made, and documents reviewed, A finding that the complaint allegation of Staff threatening resident is UNSUBSTANTIATED meaning that although the allegations may have happened there is not a preponderance of evidence to prove that the allegation occurred. Exit interview was conducted and a copy of this report was signed and emailed to the Assistant Program Director.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2022
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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