<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803870
Report Date: 02/27/2026
Date Signed: 02/27/2026 12:43:46 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
11/14/2025 and conducted by Evaluator Jill Nakagawa
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20251114094115
FACILITY NAME:A PLACE OF GRACE, INC.- MOOSUPFACILITY NUMBER:
486803870
ADMINISTRATOR:D.MITCHELL/F.HUGHESFACILITY TYPE:
737
ADDRESS:1912 MOOSUP COURTTELEPHONE:
(707) 673-2472
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:4CENSUS: 4DATE:
02/27/2026
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Dyemond Mitchell, AdministratorTIME COMPLETED:
12:47 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility did not meet Clients Care Needs
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 02/27/2026, Licensing Program Analyst (LPA) Nakagawa arrived unannounced to conclude an investigation regarding the above allegation and to deliver findings. LPA met with Administrator Dyemond Mitchell.

The complaint alleges that Facility did not meet Client’s Care Needs. The reporting party stated that client (C1) had injured themself and did not trust staff to provide help or seek mental health care for them or adequately monitor their other health concerns. LPA conducted interviews, reviewed Incident Reports and documentation regarding C1.

Continued on 9099-C....

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2026
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-20251114094115
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: A PLACE OF GRACE, INC.- MOOSUP
FACILITY NUMBER: 486803870
VISIT DATE: 02/27/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Continued from 9099...

Records indicate that there have been multiple incidents of C1 causing self-harm since 07/2025. Facility staff notified all required parties, including 911, responsible parties, North Bay Regional Center and Community Care Licensing. The facility has multiple safeguards in place to provide a safe environment for C1, including 15 minute safety checks and room and body checks (with the approval of client’s advocacy team), controlled access to items that may cause self-harm, mental health professionals providing therapy and a licensed nurse to supervise the monitoring of other health concerns. Care plan records indicate that the facility staff and specialists continually attempt to encourage and counsel C1 and provide 24 hour supervision. The facility has continued to work with C1, their responsible parties and the DDS/Regional Center Team to meet any arising needs of C1. Based on interviews, medical records, incident reports and facility documents the allegation that the Facility did not meet Client Care Needs is unsubstantiated. Although the allegation may have occurred there is not a preponderance of evidence to substantiate the allegation therefore the allegation is UNSUBSTANTIATED.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2