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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 216800881
Report Date: 05/14/2025
Date Signed: 05/14/2025 01:53:49 PM

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
01/13/2025 and conducted by Evaluator Anthony Loera
COMPLAINT CONTROL NUMBER: 21-AS-20250113121832
FACILITY NAME:SAN LUIS HOUSEFACILITY NUMBER:
216800881
ADMINISTRATOR:KAYLA HOTCHKISSFACILITY TYPE:
735
ADDRESS:396 SAN LUIS WAYTELEPHONE:
(415) 525-1082
CITY:NOVATOSTATE: CAZIP CODE:
94945
CAPACITY:6CENSUS: 6DATE:
05/14/2025
UNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Manager Program Operations, Kayla Hotchkiss TIME COMPLETED:
02:10 PM
ALLEGATION(S):
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Personal Rights
Toxins are accessible to clients
Facility staff did not provide quality meals to clients
Facility staff did not dispense medications as prescribed
INVESTIGATION FINDINGS:
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On 05/14/2025, Licensing Program Analyst (LPA) Loera met with Manager Program Operations, Kayla Hotchkiss to deliver complaint findings for the allegations “Personal Rights, Toxins are accessible to clients, Facility staff did not dispense medications as prescribed and Facility staff did not provide quality meals to clients”. During the investigation, LPA reviewed records, conducted interviews, and made observations.

Regarding the allegation of personal rights. Interviews conducted did not support the allegation as no staff have witnessed other staff being rough or speaking inappropriately to clients. Based on document review and Interviews conducted; information provided was contradicting with a lack of corroborating evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.


continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Anthony Loera
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025
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 2
Control Number 21-AS-20250113121832
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: SAN LUIS HOUSE
FACILITY NUMBER: 216800881
VISIT DATE: 05/14/2025
NARRATIVE
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Regarding the allegation toxins are accessible to clients. Based on LPAs observations and physical walk through of the facility, there was a lack of evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Regarding the allegation facility staff did not dispense medications as prescribed. LPA conducted medication check for the month of April 2025 and looked at medication records from 10/01/2024 through 01/31/2025. Based on LPAs observations and record review, there was a lack of evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Regarding the allegation facility staff did not provide quality meals to clients. Facility has a weekly food menu that includes breakfast, lunch, and dinner. When clients go on outings, they have the choice to buy food or have the facility provide them with a cold lunch. Based on document review and Interviews conducted; information provided was contradicting with a lack of corroborating evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Anthony Loera
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2