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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803378
Report Date: 03/28/2025
Date Signed: 03/28/2025 04:54:08 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 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
01/09/2025 and conducted by Evaluator Julie Florio
COMPLAINT CONTROL NUMBER: 21-AS-20250109152954
FACILITY NAME:CARE GREATFACILITY NUMBER:
486803378
ADMINISTRATOR:ZHANG, GUOLIAN (MARK)FACILITY TYPE:
735
ADDRESS:3265 VISTA DEL LAGO WAYTELEPHONE:
(707) 427-8776
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:6CENSUS: 3DATE:
03/28/2025
UNANNOUNCEDTIME BEGAN:
04:20 PM
MET WITH:Silva Rosario, House ManagerTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Sexual assault resulting in injury.
INVESTIGATION FINDINGS:
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On 3/28/2025, at approximately 4:20 PM, Licensing Program Analysts (LPAs) Julie Florio and Ethel Contreras arrived unannounced at Care Great to deliver findings for the above allegation. Reporting Party (RP) alleges in two separate complaints – one investigated at Beacon Day Program complaint #21-AS-20250109150006, and one investigated at Care Great care facility complaint # 21-AS-20250109152954 – that Client 1 (C1) incurred injuries as the result of sexual assault at either location.

LPAs Julie Florio and Robert Frank conducted 10-day investigation visit at Care Great on 01/10/2025 and made observations, conducted interviews, and obtained documents. LPA interviewed the Licensee, House Manager, and Staff 1 (S1), which revealed conflicting information concerning C1 engaging in ongoing self-injurious behaviors. Additionally, LPA Caitlynn Felias received email communication from C1’s responsible party stating they observed self-injurious behaviors resulting in bruising when C1 visited.

Continued on LIC9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2025
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 21-AS-20250109152954
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: CARE GREAT
FACILITY NUMBER: 486803378
VISIT DATE: 03/28/2025
NARRATIVE
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Continued from LIC9099....

Further, LPA Felias was informed via email from Beacon Day Program Licensee that North Bay Regional Center (NBRC) and their Quality Assurance Specialist investigated the situation which included having C1’s behaviorist conduct a day-long site visit to observe, and this led to the conclusion that C1’s injuries were self-inflicted and not a result of sexual assault. Beacon Day Program Licensee states that C1’s psychiatrist agreed with this conclusion. LPA Florio spoke with NBRC Service Coordinator on 3/28/2025 who confirmed that C1's care team met via Zoom on 2/14/2025 and all agreed that the injuries were self-inflicted. NBRC Service Coordinator informed LPA that they discussed appropriate interventions and safety measures with facility and that C1's IPP will be updated in May or possibly sooner. Additionally, LPA obtained an updated addendum to C1's behavior plan from the care facility on 3/28/2025 which reflects the interventions and safety measures discussed in the care team meeting conducted 2/14/2025.

Based on record review, interviews conducted, and observations made, the allegation of sexual assault resulting in injury is UNSUBSTANTIATED. A finding that the complaint allegation is unsubstantiated means that 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.

No Deficiencies cited during visit.

Exit interview conducted. Copy of report discussed and provided to House Manager. Signature on form confirms receipt of documents.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2