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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 216801723
Report Date: 02/28/2024
Date Signed: 02/28/2024 02:39:49 PM

Substantiated


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
02/21/2024 and conducted by Evaluator Helena Rummonds
COMPLAINT CONTROL NUMBER: 21-AS-20240221164356
FACILITY NAME:BEACON HILLFACILITY NUMBER:
216801723
ADMINISTRATOR:BENOIT, WILSONFACILITY TYPE:
735
ADDRESS:826 HAYDEN AVE.TELEPHONE:
(415) 897-9716
CITY:NOVATOSTATE: CAZIP CODE:
94945
CAPACITY:6CENSUS: 4DATE:
02/28/2024
UNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Licensee, Wally Hyppolite and Administrator, Wilson BenoitTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff are not ensuring that the facility is free of insects and rodents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Helena Rummonds arrived unannounced at approximately 1:10PM to initiate a complaint investigation regarding the above allegation. LPA was greeted by staff and discussed the purpose of the visit. Licensee, Wally Hyppolite and Administrator, Wilson Benoit arrived shortly after.

LPA initiated a tour of the kitchen and upstairs bathroom and observed the kitchen to have sticky traps behind the refrigerators that had live cockroaches on them. Licensee confirmed that mice have been getting into the kitchen through a small hole in the wall. Per conversation with Licensee, they will be contacting the exterminator and are in the process of starting a kitchen remodel. Based on interview and observation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Helena Rummonds
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024
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-20240221164356
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: BEACON HILL
FACILITY NUMBER: 216801723
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/29/2024
Section Cited
CCR
80087(a)(1)
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80087 Buildings and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times...
(1) The licensee shall take measures to keep the facility free of flies and other insects. This requirement was not met as evidenced by:
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Licensee agrees to submit a plan for how they are going to ensure that the facility will be kept free from insects and rodents. Licensee agrees to submit plan by POC due date of 02/29/2024 and then agrees to submit proof of exterminator service once completed.
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Based on interview and observation, licensee confirmed that mice have been getting in through a small hole in the kitchen, and LPA observed cockroaches on sticky trap behind the refrigerator.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Helena Rummonds
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2