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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486801876
Report Date: 07/29/2024
Date Signed: 07/29/2024 01:53:50 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
05/15/2024 and conducted by Evaluator Jill Nakagawa
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20240515130706
FACILITY NAME:A PLACE OF GRACE INC LA CRUZ LANEFACILITY NUMBER:
486801876
ADMINISTRATOR:AMBER PALESIFACILITY TYPE:
735
ADDRESS:851 LA CRUZ LNTELEPHONE:
(707) 447-6393
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY:6CENSUS: 4DATE:
07/29/2024
UNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Roman Price, House ManagerTIME COMPLETED:
01:55 PM
ALLEGATION(S):
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Staff are interfering with how resident uses their cash resources
Staff are smoking marijuana in the facility while on duty
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced on 7/29/2024 to complete the investigation and deliver findings on the above allegations.

LPA Nakagawa interviewed 4 of 4 residents regarding the above allegation “Staff are smoking marijuana in the facility while on duty”. 1 resident stated they never smelled marijuana in the facility; 3 of 4 residents interviewed stated that they smelled marijuana in the facility on one instance but 0 of 3 could specify a date or time (only that it was in the evening) nor could they identify staff who were present at the time of the incident. LPA intervewed 3 of 6 staff.
Continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2024
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-20240515130706
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: A PLACE OF GRACE INC LA CRUZ LANE
FACILITY NUMBER: 486801876
VISIT DATE: 07/29/2024
NARRATIVE
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Continued from 9099....

Staff (S1) stated that they had noticed the smell of marijuana coming from the neighbors on more than one occasion, saying that it was possible that the smell could have come from outside the facility. 3 of 3 staff interviewed had no knowledge of any incidents of marijuana in the facility.

As no one was able to provide the identities of participants or a particular date or time there is no evidence to corroborate this allegation “Staff are smoking marijuana in the facility while on duty”. 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.

LPA Nakagawa also investigated the allegation that “Staff are interfering with how resident uses their cash resources”. The Administrator, Licensee and 3 of 4 residents stated residents are allowed to access and spend their money as they wish. 3 of 4 residents corroborated that they were able to spend their money on whatever they want, although staff may coach them on making good choices, it is ultimately up to the residents to spend their money as they see fit. The only limitations to spending their money would be transportation, which is dependent on staffing and availability of a van.


LPA found no evidence that “Staff are interfering with how residents use their cash resources”. 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: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2