486804177-12-18-2025-21-AS-BMOS-DPLUDW-20251222143012

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486804177
Report Date: 12/18/2025
Date Signed: 12/18/2025 10:22:31 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
10/21/2025 and conducted by Evaluator Star Stevenson

COMPLAINT CONTROL NUMBER: 21-AS-20251021113655

FACILITY NAME:	Q & R RESIDENTIAL FACILITY LLC		FACILITY NUMBER:	486804177
ADMINISTRATOR:	PEARSON, ROSHAWN		FACILITY TYPE:	735
ADDRESS:	2707 WHITE ALDER CT		TELEPHONE:	(707) 759-6774
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94533
CAPACITY:	5	CENSUS: 4	DATE:	12/18/2025
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Deajah Jefferson - Designation of Facility Responsibiltiy		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Resident was sexually abused by another resident of the facility

INVESTIGATION FINDINGS:

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At approximately 9:45 AM Licensing Program Analyst (LPA) Stevenson arrived unannounced to conduct a complaint investigation and delivered findings regarding the allegation listed above and met with caregiver Deajah Jefferson who has Designation of Faciltiy Responsibilty (RP)
There was an allegation of a client (C2) being sexually abused by client (C1) at the facility. On 10/21/25, there was a SOC341 form submitted by the reporting party, reporting staff’s failure to adequately supervise client C1 who allegedly sexually abused client C2, C2 made the alligation to an outside party.
The Fairfield Police Department advised they would not be following up with an investigation of the allegations due to lack of supporting evidence. The complaint was returned to LPA for review as the incident appeared to be more consistent with personal rights violations versus sexual abuse.

During the course of Community Care Licensing’s investigation, the department and department investigator conducted record reviews, interviews with staff and clients, and reviewed combined available video surveillance footage associated to the incidents between C2 and C1.
Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2025

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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Control Number 21-AS-20251021113655

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: Q & R RESIDENTIAL FACILITY LLC	FACILITY NUMBER: 486804177
	VISIT DATE: 12/18/2025

NARRATIVE

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Continued from LIC9099
Based on interviews conducted and records obtained the investigation revealed that C2 was unable to describe the details of how C1 touched them inappropriately during both incidents. In addition, to further mitigate future incidents the facility indicated to the department investigator they are looking to move C2 to a separate facility.

Based on a confidential interview conducted with former staff member (S3) who was working at the time of both incidents, it was revealed that neither C1 nor C2 required constant, line-of-sight supervision, a claim that was backed up by medical record review. S3 also revealed that they did not physically see either event as they happened.

Interviews with C2 confirmed that none of the staff or other clients physically saw either events of 10/17/2025 or 10/20/2025 and C2 further relayed the fact that they did not report the events of 10/20/2025 that occurred in the backyard of the facility to other clients or staff at the facility, until making their concerns known to outside party.

Based on interviews, record and video reviews, the allegation of C2 being sexually abused by C1 or of that of a Personal Rights violation is Unsubstantiated.

A finding that the complaint is Unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

Report was reviewed with RP, whose signature denotes receipt.

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2025

LIC9099 (FAS) - (06/04)

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