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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486801953
Report Date: 03/19/2024
Date Signed: 04/09/2024 09:31:44 AM

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
02/21/2024 and conducted by Evaluator Jill Nakagawa
COMPLAINT CONTROL NUMBER: 21-AS-20240221083310
FACILITY NAME:RICHARD'S HAPPY HOMEFACILITY NUMBER:
486801953
ADMINISTRATOR:TROY RICHARDFACILITY TYPE:
735
ADDRESS:254 DONEGAL COURTTELEPHONE:
(707) 448-2838
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY:6CENSUS: 4DATE:
03/19/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Ocie RichardTIME COMPLETED:
10:10 AM
ALLEGATION(S):
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Licensee does not ensure the staircase is in repair
Licensee does not ensure facility is free of tripping hazards
Client sustained an unexplained head injury
INVESTIGATION FINDINGS:
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LIcensing Program Analysts (LPAs) Nakagawa and Mutialu arrived unannounced to deliver findings on the above allegations.

The complaint alleges that the Licensee does not ensure the staircase is in repair and Licensee does not ensure facility is free of tripping hazards. It is alleged that broken tiles were observed on the landing of the stairway. LPAs Nakagawa and Mutialu conducted an inspection on 3/19/24 and found a cracked tile, but still affixed to subfloor and the stairway was free of loose tiles. Any loose tiles had been repaired.
(Continued on 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024
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 3
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
02/21/2024 and conducted by Evaluator Jill Nakagawa
COMPLAINT CONTROL NUMBER: 21-AS-20240221083310

FACILITY NAME:RICHARD'S HAPPY HOMEFACILITY NUMBER:
486801953
ADMINISTRATOR:TROY RICHARDFACILITY TYPE:
735
ADDRESS:254 DONEGAL COURTTELEPHONE:
(707) 448-2838
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY:6CENSUS: 4DATE:
03/19/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Ocie RicharTIME COMPLETED:
10:10 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13



Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 21-AS-20240221083310
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: RICHARD'S HAPPY HOME
FACILITY NUMBER: 486801953
VISIT DATE: 03/19/2024
NARRATIVE
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 There were no tripping hazards found and the staircase was free of debris, steps were secure, and handrails were safe and securely attached to walls along the staircase, providing a facility free of tripping hazards.

The complaint alleges that Client (C1) sustained an unexplained head injury. LPA Nakagawa conducted interviews and reviewed records. It was determined that C1 has a history of bumps on their head which are not the result of injury or trauma but an underlying health condition.

Although the allegations may have happened or are valid based on interviews, record review and observations made by the LPAs at the time of visit, the preponderance of evidence standard has been met, therefore, the above allegations are found to be UNSUBSTANTIATED.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3