216803333-2-21-2025-21-AS-KMOA-DHDRXK-20250606132446

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 216803333
Report Date: 02/21/2025
Date Signed: 02/21/2025 03:05:57 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
02/14/2025 and conducted by Evaluator Anthony Loera

COMPLAINT CONTROL NUMBER: 21-AS-20250214163627

FACILITY NAME:	SUNDANCE VILLA INC.		FACILITY NUMBER:	216803333
ADMINISTRATOR:	WILSON, LESLIE		FACILITY TYPE:	740
ADDRESS:	1414 CAMBRIDGE STREET		TELEPHONE:	(415) 892-7641
CITY:	NOVATO	STATE: CA	ZIP CODE:	94947
CAPACITY:	4	CENSUS: 3	DATE:	02/21/2025
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Leslie Wilson, Administrator		TIME COMPLETED:	03:18 PM

ALLEGATION(S):

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Staff have inappropriate visiting hours

INVESTIGATION FINDINGS:

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On 02/21/2025, Licensing Program Analyst (LPA) Loera conducted an unannounced visit for the purpose of initiating a complaint investigation regarding the above complaint and delivering complaint findings. LPA arrived and met with Administrator, Leslie Wilson. During the investigation, LPA conducted interviews with staff and made observations.

Compliant alleges, Staff have inappropriate visiting hours. Report was received 02/14/2025, alleged visiting hours start late.

Based upon department document review, information provided was contradicting with a lack of corroborating evidence to support the allegation. Resident(s) admission agreement(s) state visiting hours are 1pm to 5pm and were signed by resident(s) responsible parties. Hours of visiting are posted on facilities front door.

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.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5071
LICENSING EVALUATOR NAME: Anthony Loera	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

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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