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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486804093
Report Date: 09/26/2024
Date Signed: 09/26/2024 10:35:14 AM

Substantiated


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
06/13/2024 and conducted by Evaluator Julie Florio
COMPLAINT CONTROL NUMBER: 21-AS-20240613105443
FACILITY NAME:SPECIAL CARE 3FACILITY NUMBER:
486804093
ADMINISTRATOR:AUJLA, HARJITFACILITY TYPE:
735
ADDRESS:1753 VENTURA WAYTELEPHONE:
(707) 207-3901
CITY:SUISUNSTATE: CAZIP CODE:
94585
CAPACITY:4CENSUS: 3DATE:
09/26/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:HARJIT AUJLA, Licensee/AdministratorTIME COMPLETED:
10:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Lack of supervision resulting in client attacking another client
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At approximatetly 9:30 AM, Licensing Program Analyst (LPA) JUlie Florio arrived unannounced to deliver findings regarding the above complaint allegation. Harjit Aujla, Licensee, was contacted via telephone and arrived at approximately 9:45 AM.

For the allegation lack of supervision resulting in client attacking another client – Complaint alleges that client C1 was observed to have multiple bite marks and scratches on both arms, a right side black eye, and a bloodspot mark. It was reported that C1 was attacked by another client in the home, C2. Per complaint, C1 called for help several times and nobody came. Per review of reports and interview with Licensee, there were two staff in the facility at the time of the incident. One was using the restroom, and another was assisting another client. Clients were heard by staff having a discussion that escalated resulting in an altercation. Staff was able to respond and separate clients.

Continued on LIC9099A....
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
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 3
Control Number 21-AS-20240613105443
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: SPECIAL CARE 3
FACILITY NUMBER: 486804093
VISIT DATE: 09/26/2024
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 LIC9099...

Following incident, client’s conservator was notified, and facility has since responded by redirecting client’s earlier, starting a reward system and medication changes. Review of C2’s Individual Program Plan (IPP) indicates that C2 requires “24/7 line-of-sight supervision.” Based on interview and document review, staff did not have line of sight of C2 as required by their IPP.

Based on interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, are being cited on the attached LIC 9099D. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 21-AS-20240613105443
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: SPECIAL CARE 3
FACILITY NUMBER: 486804093
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/26/2024
Section Cited
CCR
80078(a)
1
2
3
4
5
6
7
Responsibility for Providing Care and Supervision: The licensee shall provide care and supervision as necessary to meet the client's needs.

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee states facility has since responded by redirecting client’s earlier, starting a reward system for successful self-regulation and medication changes. POC cleared today 9/26/2024.
8
9
10
11
12
13
14
Based on record review and interview, the licensee did not comply with the section cited above when staff did not maintain required supervision resulting in altercation between clients which poses an immediate health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3