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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803837
Report Date: 06/29/2023
Date Signed: 07/05/2023 11:28:09 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
04/17/2023 and conducted by Evaluator Araceli Canela
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20230417121739
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:
06/29/2023
UNANNOUNCEDTIME BEGAN:
03:43 PM
MET WITH:Fritzie CubeTIME COMPLETED:
05:29 PM
ALLEGATION(S):
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Client personal needs are not being met by care staff
Personal Rights
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.

LPA made observations, and previously reviewed, requested records and received statements. On today's visit LPA took additional statement and reviewed more records. It was alleged Client personal needs are not being met by care staff, in that C1 is not being assisted with showers or changed. LPA received contradicting statements from C1, in that staff were not assisting with showers and, that staff do ask C1 if they would like to be showered, but C1 sometimes refuses showers. C1 also disclosed that sometimes staff take long to change C1 but not sure of how long, but they do change client. Staff S1 disclosed they were recently hired to provided 1 to 1 care to C1 and C1 has refused showers for the past 2 week on the days that S1 provides assistance. 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)
Page: 1 of 2
Control Number 21-AS-20230417121739
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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Additional staff interviewed stated they offer C1 showers daily but C1 refuses, they also offer bed baths and change C1. C1 at times becomes verbally aggressive, if they ask or encourage C1 to take a shower.

It was also alleged C1's Personal Rights are violated in that staff yell at C1.
Staff deny the allegation and expressed they never yell at any clients or have seen any staff yell at any clients. C1 expressed they feel staff get mad when they need assistance, but could not provide an example. LPA did not get any corroborating statements from other clients or C1's family member as they did not return LPAs calls.

Based on records reviewed and interviews conducted, the allegations for, Client personal needs are not being met by care staff & Personal Rights, is found to be Unsubstantiated, meaning that, 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 allegations are both, 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)
Page: 2 of 2