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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803540
Report Date: 06/28/2022
Date Signed: 06/28/2022 11:09:57 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
06/03/2022 and conducted by Evaluator David Leibert
COMPLAINT CONTROL NUMBER: 21-AS-20220603125601
FACILITY NAME:PEOPLE'S CARE MORNING SUNFACILITY NUMBER:
486803540
ADMINISTRATOR:HENRY, STEPHANIEFACILITY TYPE:
735
ADDRESS:707 MORNING SUN CTTELEPHONE:
(707) 449-3935
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY:4CENSUS: DATE:
06/28/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Renee DillardTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility not providing adequate supervision to resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst Leibert arrived unannounced for the purpose of delivering findings on this complaint. LPA meet with Renee Dillard and discussed the allegation. During the course of this investigations, site visits were made to the facility, records were obtained, records and regulations were reviewed, and statements taken from witnesses and staff. Based upon the statements and records, the following determinations are made: Facility records for C1 contain contradicting information regarding the level of supervision required for C1 who left the facility on or about March 20, 2022 and trespassed on neighboring property; Physician Assessment (LIC602) for C1 of January 02, 2022 indicates C1 is able to leave the facility unassisted; No theft or damage has been reported and C1 returned to facility after a short absence; Alarm for C1's bedroom window had been turned off in order to open window to air out the bedroom. Although the allegation may be true, based upon the statements and records, the preponderance of evidence standard has not been met. Therefore, the allegation is UNSUBSTANTIATED.
Report left at facility.
No citations issued for this complaint.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carla Martinez
LICENSING EVALUATOR NAME: David Leibert
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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