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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 480102381
Report Date: 04/28/2022
Date Signed: 04/28/2022 12:50:14 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/04/2022 and conducted by Evaluator Dominic Tobola
COMPLAINT CONTROL NUMBER: 21-AS-20220204121421
FACILITY NAME:JO-MIL GROUP HOMEFACILITY NUMBER:
480102381
ADMINISTRATOR:CHERYL DAVIDSONFACILITY TYPE:
735
ADDRESS:143 RUTGERSTELEPHONE:
(707) 553-1581
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY:6CENSUS: 4DATE:
04/28/2022
UNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Cheryl Davidson, AdministratorTIME COMPLETED:
01:10 PM
ALLEGATION(S):
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Resident's funds are being misappropriated.
INVESTIGATION FINDINGS:
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On 4/28/2022 LPA Tobola conducted a complaint investigation for the purpose of delivering findings to the facility and was greeted by Administrator, Cheryl Davidson. During the course of the investigation, LPA conducted a tour of the facility, made observations, interviewed staff and clients and reviewed facility and client records.

Complaint alleges resident's funds are being misappropriated. Upon interviews with staff, clients, NBRC representative (R1) and a review of clients' (C1) & (C2) bank card transactions, LPA found that although there were transactions under C1's bank account that RP claimed to be fraudulent, LPA and NBRC did not have corroborating evidence to associate any of the transactions directly to staff (S1) or Licensee.

In addition, based on interviews with Licensee and NBRC representative LPA found that C1 had requested to hold responsibility of handle their own finances. NBRC, C1 and Administrator held a meeting between May and July 2021 agreeing that C1 was able to handle their own finances, however the Adminstrator was not provided an updated addendum Individual Program Plan documenting the approved change from NBRC.
Continued onto LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022
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-20220204121421
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: JO-MIL GROUP HOME
FACILITY NUMBER: 480102381
VISIT DATE: 04/28/2022
NARRATIVE
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A finding that the complaint allegation resident's funds are being misappropriated is found to be unsubstantiated meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

No deficiencies cited during today's visit. Appeal Rights Given.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2