486803937-8-20-2021-21-AS-KMOA-C6DLTU-20210830090251

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803937
Report Date: 08/20/2021
Date Signed: 08/20/2021 12:09:02 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/16/2021 and conducted by Evaluator Dominic Tobola

COMPLAINT CONTROL NUMBER: 21-AS-20210616101703

FACILITY NAME:	WARD RESIDENTIAL CARE HOME I		FACILITY NUMBER:	486803937
ADMINISTRATOR:	POQUIZ, ALICIA		FACILITY TYPE:	740
ADDRESS:	110 WARD CT		TELEPHONE:	(707) 643-6331
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94589
CAPACITY:	6	CENSUS: 6	DATE:	08/20/2021
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Grace Samonte, Lead Carestaff		TIME COMPLETED:	12:20 PM

ALLEGATION(S):

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Illegal eviction

INVESTIGATION FINDINGS:

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On 8/20/2021 Licensing Program Analyst (LPA) Tobola conducted a compalint visit to deliver investigation findings and met with Lead Carestaff, Grace Samonte. Facility was toured, facility client files were reviewed and interviews with staff and outside parties were conducted.

Complaint alleges the facility conducted an illegal eviction for client C1. Based upon record review and interviews with staff and Solano County Case Manager/Conservator and Housing Manager for C1, LPA found that there was miscommunication regarding C1's transfer to another facility. Although, Licensee notified the Housing Manager of C1's transfer the information was miscommunicated to the Conservator from the Housing Manager. LPA received conflicting information from various parties that discussed C1's transfer.

A finding that the complaint allegations illegal eviction is 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. Appeal Rights Given.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Dominic Tobola	TELEPHONE: (707) 588-5081
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2021

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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