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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803852
Report Date: 07/26/2024
Date Signed: 07/26/2024 04:55:18 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
05/20/2024 and conducted by Evaluator Dominic Tobola
COMPLAINT CONTROL NUMBER: 21-AS-20240520121056
FACILITY NAME:THRIVE ADULT RESIDENTIAL CARE II, INC.FACILITY NUMBER:
486803852
ADMINISTRATOR:MARIA GOLITZENFACILITY TYPE:
735
ADDRESS:2340 CABOT CTTELEPHONE:
(510) 689-4911
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:4CENSUS: 3DATE:
07/26/2024
UNANNOUNCEDTIME BEGAN:
04:08 PM
MET WITH:David Salamida, Lead StaffTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility did not serve appropriate foods resulting in client weight loss
Facility did not supervise clients in care
INVESTIGATION FINDINGS:
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On 7/26/2024, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of delivering complaint investigation findings and was greeted by Lead Staff, David Salamida. LPA toured the facility, interviewed staff, client and outside parties and made observations during the course of the investigation.

Complaint alleges facility did not serve appropriate foods resulting in client (C1) weight loss. Based upon tour of the facility LPA observed an ample amount of healthy and balance foods for clients in care. In addition, on 5/24/2024, LPA toured the facility and observed frozen chicken nuggets, lasagna and fish sticks all of which were preferred meals for C1. C1 was no longer residing in the facility upon opening of investigation. LPA attempted but was unable to interview C1 due to refusal at initial contact. Upon following attempts, phone contact for C1 was found to be disconnected. Upon record review and interview with staff (S1) it was found that C1 did have loss in weight from time admitted to time discharged. However, based upon interviews with staff (S1) it was indicated that staff encouraged C1 to eat, but C1 often refused or skipped meals, including their preferred food items.
Continued onto LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
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-20240520121056
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: THRIVE ADULT RESIDENTIAL CARE II, INC.
FACILITY NUMBER: 486803852
VISIT DATE: 07/26/2024
NARRATIVE
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Complaint alleges facility did not supervise clients in care involving client (C1) allegedly victimized in an unwanted sexual advance from client (C2). Based upon interviews with staff (S1) and client (C2), information provided was contradicting from allegation. LPA attempted but was unable to interview C1 due to refusal at initial contact. Upon following attempts, phone contact for C1 was found to be disconnected. In addition, It was found that Fairfield Police Department had conducted an additional interview with C2 regarding the allegation. A pending police report has been requested. Due to a lack of corroborating evidence the allegation is unsubstantiated. However, the department may reopen investigation based on police report findings.

A finding that the complaint allegations, facility did not serve appropriate foods resulting in client weight loss
and facility did not supervise clients in care are unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

No deficiencies cited.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2