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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803837
Report Date: 11/18/2022
Date Signed: 11/18/2022 07:07:24 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
05/17/2022 and conducted by Evaluator Araceli Canela
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20220517133529
FACILITY NAME:GREENFIELDS HOMEFACILITY NUMBER:
486803837
ADMINISTRATOR:BADILLO, JASMINE CFACILITY TYPE:
735
ADDRESS:116 MORGAN STTELEPHONE:
(707) 563-5151
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:4CENSUS: 4DATE:
11/18/2022
UNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Fritzie CubeTIME COMPLETED:
05:06 PM
ALLEGATION(S):
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Sexual Assault
Clients nutritional needs are not being met


INVESTIGATION FINDINGS:
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The Department conducted a complaint investigation regarding the allegations listed above. Licensing Program Analyst (LPA) Araceli Canela arrived unannounced for the purpose of closing the investigation and met with facility manager, Fritzie Cube.

On 5/18/2022, LPA Araceli Canela toured the facility; acquired documentation; and made observations of the facility. During documentation review, observation, and investigation conducted & completed by our IB investigator, J. Barajas, on 11/15/2022 for the above Sexual Assault allegation, the following was reported. Client C1, reported the assault occurred in May 2021, by staff S1. The Vallejo PD concluded their investigation, due to discrepancies in C1's allegation and C1's history of making false allegations to the department.

Continue report see LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Araceli Canela
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022
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 3
Control Number 21-AS-20220517133529
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: GREENFIELDS HOME
FACILITY NUMBER: 486803837
VISIT DATE: 11/18/2022
NARRATIVE
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 Staff S1 denied the allegations and stated they worked at this facility for a few months, around January 2020 and did not work at this Greenfields facility in May of 2021, and other staff confirmed this information. Staff interviewed did not corroborate the allegation and there were no other complaints of this nature by other clients living in this facility.
It was also reported, Clients nutritional needs are not being met and C1 is malnourished and loosing weight. LPA Canela reviewed weight records and documentation shows C1's weight has been between 132 to 140.2 lbs from June 2021 to June 2022. C1 corroborated they have no concerns with food, they get plenty of food and they like what the facility provides. C1 also corroborated they have maintained pretty much the same weight, the only time was last month in October in which the facility informed them, they had lost 12 lbs, but had nothing to worry about, and then in November she was back to normal. Facility reported they notified the nurse, there may have been an issue with the weight scale as no loss of weight was noted on client C1.
Based on records reviewed, statements made, and contradicting information received, and although the allegation may be valid, there is not a preponderance of evidence to prove the allegation did or, did not, occur. Therefore, both of the above allegations for Sexual Assault and Clients nutritional needs are not being met are UNSUBSTANTIATED.



No citations issued today.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Araceli Canela
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3