486801931-7-27-2023-21-AS-KMOA-CUBL56-20230802082635

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486801931
Report Date: 07/27/2023
Date Signed: 07/27/2023 01:48:06 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
04/20/2023 and conducted by Evaluator Dominic Tobola

COMPLAINT CONTROL NUMBER: 21-AS-20230420084216

FACILITY NAME:	DUNGARVIN CALIFORNIA LLC		FACILITY NUMBER:	486801931
ADMINISTRATOR:	NOWLIN, JERAMIE		FACILITY TYPE:	775
ADDRESS:	310 E MONTE VISTA AVE STE A		TELEPHONE:	(707) 449-3722
CITY:	VACAVILLE	STATE: CA	ZIP CODE:	95688
CAPACITY:	45	CENSUS: 32	DATE:	07/27/2023
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Jeramie Nowlin, Program Director		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Personal Rights

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 7/27/2023, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of delivering complaint investigation findings. LPA toured the facility, reviewed facility records, interviewed staff and clients and made observations.

Complaint alleges the facility violated clients' personal rights regarding a witnessed incident in which staff (S1 & S2) allegedly yelled or spoke inappropriately to clients in care during a public outing in Winters, CA on 4/18/2023. Based on a review of records and interview with Care Coordinator (S3), LPA found that public outings are schedule each program day and consist of two staff providing supervision and transportation to 3-4 clients. On the outing schedule dated 4/18/2023, it was observed that outing "Group 2" with staff (S1 & S2) and clients (C1, C2 & C3) had attended an outing in Winters, CA. In addition, description of staff and day program vehicle are similar to the description from the reporting party.

Continued onto LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

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 21-AS-20230420084216

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: DUNGARVIN CALIFORNIA LLC	FACILITY NUMBER: 486801931
	VISIT DATE: 07/27/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Upon interview with DSP staff (S1), LPA confirmed that "Group 2" had partaken in lunch at the Winter's Community Park that was indicated by the reporting party. S1 had denied speaking inappropriately to clients in care and denied witnessing staff S2 or any other staff of the same behavior. S1 stated that during the outing, client C1 was in attendance and has behaviors of yelling and speaking inappropriately towards S2 and other staff. LPA conducted an interview with DSP staff (S2) who stated that they have not witnessed or themselves behave or speak inappropriately towards clients. S2 informed LPA that a specific client (C1) is known to agitate and also become agitated by other clients. S2 stated that C1 has demonstrated behaviors of yelling and saying "shut up" to other clients. Upon a review of staff files, LPA found that S1 & S2 have appropriate training on client personal rights and both are aware of reporting requirements for suspected abuse.

LPA conducted interview with client C1 who had attended the Winters Country Drive outing on 4/18/2023. C1 primarily responds to yes and no questions. Upon interview, LPA asked C1 if they find any staff to be mean, yell or speak inappropriately to C1 or other clients. C1 responded with a no. LPA asked C1 if they feel safe and treated well in the facility and C1 responded yes. C1 was non-verbal and did not respond to a majority of LPA's questions. Clients, C2 & C3 are both non-verbal and LPA unable to conduct interview. Due to a lack of corroborating evidence and conflicting statements from interviews with staff, client and outside parties the allegation is found to be unsubstantiated.

Allegation, facility violated client personal rights is UNSUBSTANTIATED. A finding that the complaint 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. Appeal Rights given.

No deficiencies cited during visit.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2