210108757-9-4-2024-21-AS-VBEI-D8YNFJ-20240910102533

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 210108757
Report Date: 09/04/2024
Date Signed: 09/04/2024 10:17:43 AM

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
05/02/2024 and conducted by Evaluator Caitlynn Felias

COMPLAINT CONTROL NUMBER: 21-AS-20240502231417

FACILITY NAME:	AVANTI		FACILITY NUMBER:	210108757
ADMINISTRATOR:	ASHKENAZY, REBECCA		FACILITY TYPE:	735
ADDRESS:	7 LE CLAIRE COURT		TELEPHONE:	(415) 472-2875
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94903
CAPACITY:	8	CENSUS: 7	DATE:	09/04/2024
		UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	House Manager, Nakuia Morris		TIME COMPLETED:	10:25 AM

ALLEGATION(S):

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Staff mishandled the clients medications

INVESTIGATION FINDINGS:

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At approximately 9:55AM, Licensing Program Analysts (LPAs) Felias and Loera arrived unannounced to deliver findings for this Complaint Investigation regarding the above allegations and met with House Manager, Nakuia Morris.

During the course of the investigation, the Department requested and reviewed documents, conducted interviews, and made observations. There is an allegation that “Staff mishandled the clients medications.” Complainant alleged that Staff Member 1 (S1) threw a bottle of medications at a client last year. Complainant stated that they heard the information from Staff Member 2 (S2). LPA contacted the Complainant for more details but was unsuccessful. LPA conducted staff interviews. LPA conducted an interview with S1 who stated that the incident was false and denied that the incident occurred. LPA contacted S2 for more details but was unsuccessful.

Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024

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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Control Number 21-AS-20240502231417

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: AVANTI	FACILITY NUMBER: 210108757
	VISIT DATE: 09/04/2024

NARRATIVE

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Continued from LIC9099

LPA conducted client interviews. 4 of 7 client interviews conducted stated that staff members treated them well and that they haven’t seen or heard of current staff members mistreating clients. Client interviews also stated that there was a staff member that used to yell at clients, but they no longer worked at the facility.
Based on interviews conducted and lack of evidence, LPA is unable to determine if a Title 22 regulation violation has occurred. Therefore, this allegation is Unsubstantiated.

A finding that the complaint allegation is Unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

No Deficiencies Cited during visit.

Exit interview conducted. Copy of report and Confidential Names (LIC811) discussed and provided to House Manager. Signature on form confirms receipt of documents.

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024

LIC9099 (FAS) - (06/04)

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