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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803679
Report Date: 07/22/2025
Date Signed: 07/22/2025 03:54:14 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
04/15/2025 and conducted by Evaluator Jill Nakagawa
COMPLAINT CONTROL NUMBER: 21-AS-20250415124919
FACILITY NAME:A PLACE OF GRACE INC NOVATO DRIVEFACILITY NUMBER:
486803679
ADMINISTRATOR:MCCART,DIANEFACILITY TYPE:
735
ADDRESS:112 NOVATO DRTELEPHONE:
(707) 447-7634
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY:4CENSUS: 4DATE:
07/22/2025
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Diane McCart via phoneTIME COMPLETED:
04:00 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 7/22/2025, LPA Nakagawa arrived unannounced at A Place of Grace Novato to deliver findings regarding the above allegation. LPA met with Administrator Diane McCart via phone and staff member Sharon Hughes in office to discuss.
The allegation of personal rights being violated was reported by reporting party who stated that client C1 told them they were frequently yelled at by staff member (S1) and that they did not feel safe, although not due to physical abuse.
LPA conducted interviews with 4 of 8 staff members and 4 of 4 clients of the facility and found that 4 of the 4 staff and 4 of 4 clients interviewed stated that there were no cases of personal rights being violated. LPA interviewed Client (C1) who stated that at the time of visit with the reporting party they were upset with S1 because S1 had asked C1 to take a shower; S1 had not violated their personal rights, just made C1 mad. According to S1, S1 was doing their job to help C1 meet the goals and objectives of their Individual Program Plan (IPP): practice good hygiene - not violate personal rights. Based on the statements of C1 and S1 and the IPP goal which was agreed to by C1; the allegation that personal rights were violated is unsubstantiated. Although the allegation of personal rights may have happened there is not a preponderance of evidence to substantiate the allegation therefore the allegation is unsubstantiated

No deficiencies cited.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
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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