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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397006143
Report Date: 09/05/2025
Date Signed: 09/05/2025 04:23:09 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CRP RO, 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
06/02/2025 and conducted by Evaluator Tatyana Shulz
PUBLIC
COMPLAINT CONTROL NUMBER: 23-CR-20250602114150
FACILITY NAME:YAI DAVIS RD. COMMUNITY CRISIS HOME (CCH)FACILITY NUMBER:
397006143
ADMINISTRATOR:ROMER JOHN DELA CRUZFACILITY TYPE:
727
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:4CENSUS: 4DATE:
09/05/2025
UNANNOUNCEDTIME BEGAN:
10:53 AM
MET WITH:Zach O'Dell- Lead RBTTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff did not provide a safe facility environment to minors in care
INVESTIGATION FINDINGS:
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On September 5, 2025, at 10:53am Licensing Program Analyst (LPA) Tatyana Shulz made an unannounced visit to deliver findings to the above Community Crisis Home (CCH) and met with Zach O'Dell, Lead RBT.

Prior to the meeting LPA Shulz, conducted the 10-day inspection of the facility on 6/11/2025. No deficiencies were cited during that inspection. LPA Shulz requested, Current Staff and Client Roster, Client Schedules, Staff Schedule for May and June, Staff Contact Information, Client Face Sheets, Needs and Services plans for all clients in care, Individualized Behavior Support Plan (IBSP) for all clients in care, and Outing Schedules. LPA Shulz conducted 8 interviews and attempted 1 interview between 6/11/2025-8/28/2025.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Connie Goldie
LICENSING EVALUATOR NAME: Tatyana Shulz
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2025
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 23-CR-20250602114150
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CRP RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: YAI DAVIS RD. COMMUNITY CRISIS HOME (CCH)
FACILITY NUMBER: 397006143
VISIT DATE: 09/05/2025
NARRATIVE
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Based on evidence obtained and confidential interviews conducted during the investigation process the allegation above cannot be substantiated due to lack of evidence. Six out of eight confidential interviews stated that because several clients in the home are nonverbal, the verbalization that is used by those clients to communicate can be misconstrued as screaming. LPA Shulz on several occasions has witnessed this vocalizing when the clients have become agitated, noting that it was loud enough to be heard from outside and anywhere in the home. Lastly, LPA was unable to speak to the nonverbal clients to either confirm or deny these claims.

Although the allegation may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted, copy of this report and the Appeal Rights were discussed and provided to the licensee.

SUPERVISORS NAME: Connie Goldie
LICENSING EVALUATOR NAME: Tatyana Shulz
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2