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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486804093
Report Date: 11/19/2024
Date Signed: 11/19/2024 04:31:11 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
11/15/2024 and conducted by Evaluator Jill Nakagawa
COMPLAINT CONTROL NUMBER: 21-AS-20241115101506
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:
11/19/2024
UNANNOUNCEDTIME BEGAN:
03:36 PM
MET WITH:Harjit Aujla, AdministratorTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal rights
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 11/19/2024 Licensing Program Ananlyst (LPA) Jill Nakagawa arrived unannounced to conduct an investigation into the above allegation and was greeted by DSP. There were 3 residents at home at the time. Administrator Harjit Aujla was notified and arrived shortly after. LPA toured the facility, interviewed client and staffs and made observations during the course of the investigation.

Complaint alleges personal rights have been violated. Upon interviews with clients (C1 and C2), information provided does not support the allegation and there is no evidence to prove the alleged violation occurred. Clients (C1 and C2) have indicated that there are no concerns with their personal rights being violated therefore the allegation that personal rights were violated is
found to be UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
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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