486803808-5-9-2022-21-AS-KMOA-CG4N9M-20220707101608

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803808
Report Date: 05/09/2022
Date Signed: 05/09/2022 04:31:58 PM

Unfounded

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
02/16/2022 and conducted by Evaluator Araceli Canela

COMPLAINT CONTROL NUMBER: 21-AS-20220216100627

FACILITY NAME:	COGIR OF VALLEJO HILLS		FACILITY NUMBER:	486803808
ADMINISTRATOR:	DOWELL, CAROL		FACILITY TYPE:	740
ADDRESS:	350 LOCUST DRIVE		TELEPHONE:	(707) 266-6822
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94591
CAPACITY:	80	CENSUS: 36	DATE:	05/09/2022
		UNANNOUNCED	TIME BEGAN:	02:40 PM
MET WITH:	Kaitlyn Clarey, current Administrator		TIME COMPLETED:	04:08 PM

ALLEGATION(S):

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Staff is financially abusing resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), A. Canela arrived unannounced, for the purpose of delivering findings regarding the above allegations and met with current Administrator, Kaitlyn Clarey.
It was alleged facility staff financially abusing resident in care, more specifically that resident R1 purchased a brand new vehicle for a staff.
LPA conducted facility visits, requested/reviewed records and gathered statements. Investigation revealed, staff in question, last worked September of 2021 and was no longer a current employee of Cogir of Vallejo Hills as of November of 2021. Resident R1's medical assessment indicates R1 is able to go into the community on his own and does not require the facility to provide care and supervision while R1 is out in the community. Although the incident regarding the vehicle that was purchased in January 2022 is being reviewed, the individual identified as former staff (FS1) was not an employee of this facility when incident occurred, making the complaint allegation for, staff is financially abusing resident in care, UNFOUNDED, at this time, meaning that the allegation is false and without a reasonable basis. Therefore, the complaint is DISMISSED. No citations issued

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Araceli Canela	TELEPHONE: (707) 588-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2022

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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