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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486804145
Report Date: 07/24/2025
Date Signed: 07/24/2025 11:18:40 AM

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
05/29/2025 and conducted by Evaluator Christi Coppo
COMPLAINT CONTROL NUMBER: 21-AS-20250529155142
FACILITY NAME:CLEMENT MANORFACILITY NUMBER:
486804145
ADMINISTRATOR:FERNANDEZ, FRANCIS A.FACILITY TYPE:
737
ADDRESS:7620 CLEMENT RD.TELEPHONE:
(415) 275-4262
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY:4CENSUS: 4DATE:
07/24/2025
UNANNOUNCEDTIME BEGAN:
10:09 AM
MET WITH:Francis Fernandez, AdminTIME COMPLETED:
11:32 AM
ALLEGATION(S):
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Staff is sleeping during the NOC shift
Licensee is not ensuring adequate staffing to ensure care and supervision
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Christi Coppo and Ethel Contreras arrived at this facility unannounced, to deliver findings into the above allegations. LPAs met with Francis Fernandez, Admin

Complaint alleges staff is sleeping during the NOC shift. Complainant states that Administrator (Admin) Francis falsely lists himself as working the NOC shift in order to meet ratio requirements, and if Admin is there he sleeps in his office while working the NOC shift. During investigation, LPA conducted staff and client interviews. Clients are unable to communicate as they are either non-verbal or do not have the cognitive capacity to answer LPAs’ questions. Staff reported they had never seen Francis asleep on the NOC shift. During investigation, LPA received and reviewed facility staff schedule. Schedule shows Admin Francis present for both evening shift from 2pm-11pm and NOC shift from 10pm-7am. LPA questioned Admin if this was correct. Admin advised LPA that yes, it is correct, but that he does sleep during the

COntinued on 909C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
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 4
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
05/29/2025 and conducted by Evaluator Christi Coppo
COMPLAINT CONTROL NUMBER: 21-AS-20250529155142

FACILITY NAME:CLEMENT MANORFACILITY NUMBER:
486804145
ADMINISTRATOR:FERNANDEZ, FRANCIS A.FACILITY TYPE:
737
ADDRESS:7620 CLEMENT RD.TELEPHONE:
(415) 275-4262
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY:4CENSUS: 4DATE:
07/24/2025
UNANNOUNCEDTIME BEGAN:
10:09 AM
MET WITH:Francis Fernandez, AdministratorTIME COMPLETED:
11:32 AM
ALLEGATION(S):
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9
Staff do not have required certifications
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Christi Coppo and Ethel Contreras arrived at this facility unannounced, to deliver findings into the above allegation.Francis Fernandez, Admin

Complaint alleges staff do not have required certifications. Complainant states that staff do not have the required certifications required and some are not Registered Behavior Technicians (RBT). During investigation, LPAs reviewed staff certifications. While some staff did not have the actual certificate on file, all except one staff were verified as having current certification on the Behavior Analyst Certification Board (BACB) website. Staff (S1) had RBT certification, but it expired 3/28/25, per the BACB website. Per facility’s job description for Shift Lead Staff, Lead Staff are to possess certification in the Pro-Act method. Additionally, per Admin, facility does utilize Pro-ACT restraint but Admin’s Pro-ACT restraint certification expired 3/24/25. Admin does act as Shift Lead Staff at times. So, based on LPAs’ record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 Chapter 8, are being cited on the attached 9099D. Exit interview conducted with Administrator and a copy of this report given.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 21-AS-20250529155142
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: CLEMENT MANOR
FACILITY NUMBER: 486804145
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/07/2025
Section Cited
CCR
89965(a)
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89965 Personnel Requirements (a) The licensee shall ensure that each direct care lead staff person meets the following qualifications: (1) Have one year prior experience providing direct care to individuals with developmental disabilities; and be one of the following:
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Facility to show proof of certification that is active and current for S1 by plan of correction due date.
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(A) Become a Registered Behavior Technician within six months of initial employment, or (B) Be a licensed psychiatric technician, or (C) Be a Qualified Behavior Modification Professional. This requirement is not met as evidenced by: Based on LPAs and licensee observations, the licensee did not comply with the section cited above in that Staff (S1) had RBT certification, but it expired 3/28/25, per the BACB website, which poses a potential health, safety or personal rights risk to persons in care.
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Type B
07/24/2025
Section Cited
CCR
89965(i)
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89965 Personnel Requirements (i) In addition to any other required training, each direct care staff person shall have…which shall include the techniques the licensee will use to prevent injury and maintain safety regarding clients who are a danger to self or others and shall emphasize positive
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Facility to show proof of current and active Pro-Act certificate for Administrator Francis Fernandez by plan of correction due date. While delivering complaint findings, Admin showed LPAs proof of Pro-Act ceritifaction that is current and active. Deficiency cleared.
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 behavioral supports and techniques that are alternatives to physical (manual) restraints, pursuant to the following…This requirement is not met as evidenced by: Based on LPAs and licensee observations, the licensee did not comply with the section cited above in that Admin’s Pro-ACT restraint certification expired 3/24/25, which poses a potential health, safety or personal rights risk to persons in care.
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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: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 21-AS-20250529155142
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: CLEMENT MANOR
FACILITY NUMBER: 486804145
VISIT DATE: 07/24/2025
NARRATIVE
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Continued form 9099...

NOC shift. Admin stated that even though he is asleep, staff have full access to him should a resident or staff need his assistance. However, there is no requirement in regulation for awake overnight staff for Enhanced Behavior Support Homes. So, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Complaint alleges Administrator (Admin) is not ensuring adequate staffing to ensure care and supervision. Complainant states that Admin falsely lists himself as working the night shift but does not actually work, leaving the facility out of ratio as required by client’s needs. During investigation, LPAs reviewed clients ratio requirements as identified in their Individual Behavior Support Plans (IBSP). Clients C1 and C2 require a 2:1 staffing ratio and clients C3 and C4 require a 1:1 staffing ratio. LPAs reviewed LIC 500 and found the staffing schedule compliant with required staffing ratios as identified in clients’ respective IBSPs. During investigation, LPA was advised that both Francis and the co-Administrator do put themselves on the schedule as designated leads but sometimes are not actually present at the facility. However, during these times they are both available by phone and both do actually answer the phone. Staff unable to provide LPA with dates of observed absences. Therefore, LPA unable to determine if dates when not present were on dates Admin was designated as lead. Additionally, staff schedule reflects quantity of staff present to fulfill staffing ratios required by respective clients’ Individual Behavior Support Plans (IBSP). So, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted with Administrator and a copy of this report given.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4