486804229-5-20-2025-21-AS-VBEI-DH3TPC-20250527145408

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486804229
Report Date: 05/20/2025
Date Signed: 05/20/2025 09:55:58 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
05/09/2025 and conducted by Evaluator Ali Deniz

COMPLAINT CONTROL NUMBER: 21-AS-20250509130606

FACILITY NAME:	SAN LORENZO HOME		FACILITY NUMBER:	486804229
ADMINISTRATOR:	CUNNINGHAM, IRENE		FACILITY TYPE:	735
ADDRESS:	601 SAN LORENZO STREET		TELEPHONE:	(707) 330-9314
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94533
CAPACITY:	4	CENSUS: 3	DATE:	05/20/2025
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Licensee, Richard Cunningham		TIME COMPLETED:	10:05 AM

ALLEGATION(S):

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Client sustained unexplained bruising while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Ali Deniz and Caitlynn Felias arrived unannounced to conduct a complaint investigation and deliver findings regarding the above allegations and met with Licensee, Richard Cunningham.

The Department received an allegation of client sustained unexplained bruising while in care. Per reporting party observed client (C1) with a large, dark bruise on the inside of their left arm and another smaller lighter bruise on the other arm (pictures provide). According to reporting party, C1 was inquired about the origin of the bruising and C1 smiled and shook their head as if to say "No". LPAs conducted 10-day visit on 5/12/25, made observations, obtained and requested pertinent documentation, conducted interviews with staff and clients in care. Based on interviews with staff (S1, S2 & S3), LPAs learned that the bruising was likely due to
a possible side effect of C1 taking aspirin 325 mg and a topical cream that is used to treat skin conditions
Continued on LIC9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025

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-20250509130606

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: SAN LORENZO HOME	FACILITY NUMBER: 486804229
	VISIT DATE: 05/20/2025

NARRATIVE

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Continued from LIC9099...

that might cause a lightening or darkening of the skin. According to Licensee, the combination of these two medications could cause the bruising on their arm and agreed to submit supporting documentation from C1’s physician. During LPAs’ visit on 5/12/25, LPAs attempted to interview all clients (C1, C2 & C3), but they were unable to communicate due to communication challenges. Based on records review, C1’s centrally stored medication log confirmed that C1 initiated cream treatment on 5/8/25. Also, the Licensee submitted a doctor’s letter dated 5/13/25 confirming that C1 has easy bruising due to aspirin 325 mg as medication thins the blood and patient can easily bruise/bleed if accidentally cut or injured. Based on document review and interviews conducted, this allegation is Unsubstantiated. A finding that the complaint allegation is UNSUBSTANTIATED means that 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.

Exit interview conducted. Copy of report discussed and provided to Licensee. Signature on form confirms receipt of documents.

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025

LIC9099 (FAS) - (06/04)

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