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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803735
Report Date: 09/05/2023
Date Signed: 09/05/2023 04:06:01 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
07/27/2023 and conducted by Evaluator Dominic Tobola
COMPLAINT CONTROL NUMBER: 21-AS-20230727165144
FACILITY NAME:EQUIVENTURE DAY PROGRAMFACILITY NUMBER:
486803735
ADMINISTRATOR:DINGLASAN, CYNTHIAFACILITY TYPE:
775
ADDRESS:258 SUNSET AVE. STE. MTELEPHONE:
(707) 759-3888
CITY:SUISUN CITYSTATE: CAZIP CODE:
94585
CAPACITY:45CENSUS: 45DATE:
09/05/2023
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Nell Bunyi, Program ManagerTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Personal Rights
INVESTIGATION FINDINGS:
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On 9/5/2023, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of delivering complaint investigation findings. LPA Tobola toured the facility, interviewed staff and outside parties, reviewed client records, gathered facility video footage and made observations.

The complaint alleges the facility had violated client (C1) personal rights after C1 was observed being inappropriately directed by staff and exposed inappropriately during an incontinence incident. LPA Tobola interviewed outside party (I1) who indicated they had observed staff (S1 & S2) exposing client C1's back and belly while directing C1 inappropriately to the restroom. Upon interviews with staff (S1, S2, S3 & S4), LPA was provided contradicting information towards the allegation. S1 and S2 indicated that C1's shirt was held slightly above C1's lower back to prevent C1's clothing from being soiled. Upon a review of C1's files LPA found that C1 does require continence care assistance and has history of bowel impairment.

Continued onto LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023
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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Control Number 21-AS-20230727165144
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: EQUIVENTURE DAY PROGRAM
FACILITY NUMBER: 486803735
VISIT DATE: 09/05/2023
NARRATIVE
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In addition, LPA reviewed surveillance camera video from 7/20/2023 and observed C1 to be wearing an (white) undershirt while staff were holding C1's (yellow) over-shirt. C1's lower back was slightly observed on video footage but does not appear staff are pushing or pulling C1 or exposing C1 in an inappropriate manner. In addition, C1 appears to independently walk into the restroom with staff following behind. Due to a lack of corroborating evidence and contradicting statements, the allegation is found to be unsubstantiated.

Allegation, facility had 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: 09/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023
LIC9099 (FAS) - (06/04)
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