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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 297000914
Report Date: 11/08/2023
Date Signed: 11/08/2023 01:51:44 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/30/2023 and conducted by Evaluator Todd Tryon
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20230630130207
FACILITY NAME:HOUSTON AND NOBLES ADULT RESIDENTIAL CAREFACILITY NUMBER:
297000914
ADMINISTRATOR:MARK & BARBARA HOUSTONFACILITY TYPE:
735
ADDRESS:21706 JOHN BORN ROADTELEPHONE:
(530) 432-3399
CITY:PENN VALLEYSTATE: CAZIP CODE:
95946
CAPACITY:6CENSUS: 6DATE:
11/08/2023
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Josh Houston, AdministratorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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- Resident was raped by an unknown perpetrator at the facility.
- Resident was hit by an unknown perpetrator at the facility.
INVESTIGATION FINDINGS:
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On 11/8/2023 LPA Tryon visited the faciity to complete the complaint. LPA met with staff Josh Houston

Regarding the allegation that Resident was raped by an unknown perpetrator at the facility:
CCL staff has interviewed residents, staff, spoken with local law enforcement and reviewed facility records. The details learned have varied greatly from one interview to another and from one interviewer to another. Other residents and staff have denied having any knowledge of such an episode; and the story given by the person involved has varied including accusing different housemates from one telling to another; and the resident has even denied that it took place when speaking with law enforcement. Due to the above discrepancies and lack of evidence, the Department finds the allegation to be UNSUBSTANTIATED.

Regarding the allegation that Resident was hit by an unknown perpetrator at the facility:
CCL staff has interviewed residents, staff, spoken with local law enforcement and reviewed facility records. Resident R1 has told different interviewers different accounts, and denied that anything
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
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 59-AS-20230630130207
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: HOUSTON AND NOBLES ADULT RESIDENTIAL CARE
FACILITY NUMBER: 297000914
VISIT DATE: 11/08/2023
NARRATIVE
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happened while speaking with law enforcement. Another resident mentioned an altercation with R1, but circumstances were vague, and it is not clear who may have started or provoked an altercation or what really happened. At this time LPA cannot say with certainty that something actually happened or when it may have happened. Therefore, the allegation is UNSUBSTANTIATED.

The finding that an allegation is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. No deficiencies were issued.

Exit interview conducted.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2