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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496800621
Report Date: 05/19/2023
Date Signed: 05/19/2023 09:37:31 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
04/21/2023 and conducted by Evaluator Victoria Bertozzi
COMPLAINT CONTROL NUMBER: 21-AS-20230421165518
FACILITY NAME:WIMBLEDON HOUSE #1FACILITY NUMBER:
496800621
ADMINISTRATOR:BARONI, PIA E.FACILITY TYPE:
735
ADDRESS:629 WEST 3RD STREETTELEPHONE:
(707) 527-7628
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY:5CENSUS: DATE:
05/19/2023
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Staff, Julia RamirezTIME COMPLETED:
09:47 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Clients were left at facility without staff supervision
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst Bertozzi arrived unannounced to deliver findings regarding the complaint allegation and met with Staff, Julia Ramirez

Complaint alleges that a staff member was arrested leaving clients unsupervised for about an hour. During visit on 4/24/2023 staff, S1 provided the Department a police report showing that staff was arrested on 4/13/2023 and released the following day. Facility provided a staff schedule for April 2023 and a daily house duties/task dated 4/10/2023 through 4/16/2023 that tasks were completed by staff. On 4/25/2023 additional interviews were conducted that did not provide enough information to determine whether clients were left unsupervised.

A finding that the complaint allegation that clients were left at facility without staff supervision was unsubstantiated meaning that although the allegation may have happened there is not a preponderance of evidence to prove that the allegation occurred. No deficiencies cited.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Bertozzi
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023
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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