486803837-7-5-2023-21-AS-HDBI-CTWTPS-20230720145450

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803837
Report Date: 06/29/2023
Date Signed: 07/05/2023 11:22:37 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
05/10/2023 and conducted by Evaluator Araceli Canela

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20230510080338

FACILITY NAME:	GREENFIELDS HOME		FACILITY NUMBER:	486803837
ADMINISTRATOR:	BADILLO, JASMINE C		FACILITY TYPE:	735
ADDRESS:	116 MORGAN ST		TELEPHONE:	(707) 563-5151
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94591
CAPACITY:	4	CENSUS: 4	DATE:	06/29/2023
		UNANNOUNCED	TIME BEGAN:	02:01 PM
MET WITH:	Fritzie Cube		TIME COMPLETED:	03:32 PM

ALLEGATION(S):

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Sexual Abuse

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Araceli Canela arrived unannounced for the purpose of closing the investigation and met with facility manager, Fritzie Cube. Facility Administrator, Jasmine Baldillo was not present during todays visit. The Department conducted a complaint investigation regarding the allegation listed above. Investigation was conducted & completed by Community Care Licensing , Investigations Branch (IB) investigator and the following was reported.

On 05/07/2023, Client (C1) called the Vallejo Police Department (PD) and reported that facility staff (S1) inserted their fingers in C1’s vagina when C1’s diaper was changed.. C1 was transported to Kaiser Vallejo for a Sexual Abuse Response Team (SART) exam. The Forensics Medical Report: Adult/Adolescent Sexual Assault Examination indicated there were no findings noted for the exams on inner thighs, external genitalia, perennial area, vagina, or the cervix. The Kaiser Vallejo nurse that conducted the exam did not observe anything indicative of penetration.

Continue Report see: LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Araceli Canela
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023

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-20230510080338

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: 06/29/2023

NARRATIVE

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Continued Report from LIC9099

During C1's interview with Community Care Licensing , Investigations Branch (IB) investigator, C1 indicated they were not sexually or physically assaulted and staff S1 did not inappropriately touch C1.

Staff S1 denied the allegation and stated that they did not sexually assault or inappropriately touch client C1. Facility staff (S2) interviewed, indicated that they did not believe that what is alleged occurred and staff S2 who was at the facility at the time of the incident did not observe anything.

Based on records reviewed and interviews conducted by CCL IB investigator and although the allegation may be valid, there is not a preponderance of evidence to prove the allegation did or, did not, occur. Therefore, the above allegation for Sexual Abuse is UNSUBSTANTIATED.

No citations issued today.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Araceli Canela
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023

LIC9099 (FAS) - (06/04)

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