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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486804059
Report Date: 12/06/2024
Date Signed: 12/06/2024 12:07:47 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 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
09/04/2024 and conducted by Evaluator Julie Florio
COMPLAINT CONTROL NUMBER: 21-AS-20240904015421
FACILITY NAME:ARVEAH'S CARE HOMES 3FACILITY NUMBER:
486804059
ADMINISTRATOR:MARTINEZ-DAVIS, LEAHFACILITY TYPE:
740
ADDRESS:2033 MARSHALL ROADTELEPHONE:
(530) 662-6055
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY:6CENSUS: 3DATE:
12/06/2024
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:John Piolo Danting, Designated Responsible PartyTIME COMPLETED:
11:55 PM
ALLEGATION(S):
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Staff physically assaulted a resident in care.
Staff are not meeting the medical needs of a resident in care.
Staff made an inappropriate comment towards a resident in care.
INVESTIGATION FINDINGS:
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On 12/06/2024, at approximately 11:15 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to deliver findings for the above allegations and met with John Piolo Danting, Designated Responsible Party. Reporting Party (RP) alleges that Resident 1 (R1) was physically assaulted by former Staff 1 (S1), that staff talk down to R1, and that the facility is not taking R1 to the doctors to be treated or for medications.

LPA conducted 10-day on 09/06/2024 and conducted interviews, made observations, and obtained documents. LPA was able to interview 5 of 6 residents, Licensees, Staff 2 (S2), and Staff 3 (S3). The interviews provided conflicting information regarding all 3 allegations. LPA did not observe any signs of injury or neglect of residents’ care needs during inspection. LPA was informed that the Vacaville Police Department was notified of suspected abuse by a staff member.

Continued on LIC9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024
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-20240904015421
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: ARVEAH'S CARE HOMES 3
FACILITY NUMBER: 486804059
VISIT DATE: 12/06/2024
NARRATIVE
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Continued from LIC9099...

Reports were obtained which include a name not known to the facility and state an unfounded determination.

Based on interviews conducted, observations made, and record review, the allegations listed above are UNSUBSTANTIATED. A finding that complaint allegations are unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are UNSUBSTANTIATED.

No Deficiencies cited during visit.

Exit interview conducted. Copy of report discussed and provided to Designated Responsible Party, whose signature on form confirms receipt of documents.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2