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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 216801935
Report Date: 02/29/2024
Date Signed: 02/29/2024 03:28:29 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
12/19/2023 and conducted by Evaluator Helena Rummonds
COMPLAINT CONTROL NUMBER: 21-AS-20231219102355
FACILITY NAME:CAMBRIDGE HOUSEFACILITY NUMBER:
216801935
ADMINISTRATOR:LAKEDA BROWN-STEWARDFACILITY TYPE:
735
ADDRESS:1420 CAMBRIDGE STREETTELEPHONE:
(415) 898-4262
CITY:NOVATOSTATE: CAZIP CODE:
94947
CAPACITY:6CENSUS: 6DATE:
02/29/2024
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Manager of Program Operations, Kayla HotchkissTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Staff are not properly trained
INVESTIGATION FINDINGS:
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At approximately 1:50PM, Licensing Program Analyst (LPA) Helena Rummonds arrived unannounced to continue a complaint investigation regarding the above allegation and met with Manager of Program Operations, Kayla Hotchkiss.

Complaint alleges that staff are not properly trained. Per LPA review of training documentation, facility is not following their training requirements as stated in their Plan of Operation. Facilities Plan of Operation states that staff will be receiving 24 hours of annual training. 6 out of 9 staff training records reviewed did not meet the required 24 hours of annual training as stated in facilities Plan of Operation.

Based on record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiencies are 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: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024
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-20231219102355
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: CAMBRIDGE HOUSE
FACILITY NUMBER: 216801935
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/07/2024
Section Cited
CCR
80022(k)
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80022 Plan of Operation
(k) The facility shall operate in accordance with the terms specified in the Plan of Operation and may be cited for not doing so.
This requirement was not met as evidenced by:
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Manager of Program Operations agrees to submit a plan on how they will operate within the terms specified in their Plan of Operation regarding staff training. Plan shall include how they will ensure staff are receiving initial and annual training and how hours will be tracked.
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Based on record review, the licensee did not comply with the section cited above by not ensuring that facility staff was receiving 24 hours of annual training as stated in their Plan of Operation.
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Manager agrees to submit plan to LPA by POC due date of 03/07/2024.
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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: 02/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2