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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 216803577
Report Date: 02/05/2026
Date Signed: 02/05/2026 12:02:57 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
12/26/2025 and conducted by Evaluator Anthony Loera
COMPLAINT CONTROL NUMBER: 21-AS-20251226091647
FACILITY NAME:WALDO HOUSEFACILITY NUMBER:
216803577
ADMINISTRATOR:LOTT, SHERIFACILITY TYPE:
735
ADDRESS:55 WALDO COURTTELEPHONE:
(415) 271-3304
CITY:SAUSALITOSTATE: CAZIP CODE:
94965
CAPACITY:5CENSUS: 5DATE:
02/05/2026
UNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Administrator, Sheri LottTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Staff did not follow reporting requirements
Staff did not provide adequate supervision to clients in care
INVESTIGATION FINDINGS:
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On 02/05/2026, Licensing Program Analyst (LPA) Loera conducted an unannounced visit for the purpose of delivering complaint findings. LPA arrived and met with Administrator, Sheri Lott. During the course of the investigation, LPA reviewed records, conducted interviews, and made observations.

Complainant stated staff did not follow reporting requirements. Complainant stated there were two incidents when client (C1) received brusing and a hairline fracture and was injured by a former staff member in December 2024. Complaint stated they do not think the facility reported the incident completely. Facility submitted a special incident report (SIR) to Community Care Licensing (CCL) for both incidents on 11/14/2024 and 08/04/2025. CCL also received a follow up letter indicating C1 reported additional information from the incident on 11/14/2024. Facility made appropriate protocols by reporting the incidents to CCL. Document review shows the department followed up on the incident reported on 08/04/2025 addressing the brusing during a complaint investigation 21-AS-20250811105448. The department also followed up on the incident reported on 11/14/2024 addressing injury by a former staff during a complaint investigation 21-AS-20250602155927.

continued on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Anthony Loera
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2026
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-20251226091647
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: WALDO HOUSE
FACILITY NUMBER: 216803577
VISIT DATE: 02/05/2026
NARRATIVE
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Complainant stated staff did not provide adequate supervision to clients in care. Department review shows this allegation was addressed in complaint 21-AS-20251231112418 and was found to be unsubstantiated on 02/05/2026.

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: 02/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2