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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496801563
Report Date: 01/22/2024
Date Signed: 01/22/2024 09:11:24 AM

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
11/20/2023 and conducted by Evaluator Marisol Cuadra
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20231120150114
FACILITY NAME:BECOMING INDEPENDENT-SANTA ROSAFACILITY NUMBER:
496801563
ADMINISTRATOR:COX, JAMESFACILITY TYPE:
775
ADDRESS:1455 CORPORATE CENTER PKWY.TELEPHONE:
(707) 524-6600
CITY:SANTA ROSASTATE: CAZIP CODE:
95407
CAPACITY:285CENSUS: 150DATE:
01/22/2024
UNANNOUNCEDTIME BEGAN:
08:39 AM
MET WITH:James Cox (Administrator)TIME COMPLETED:
09:26 AM
ALLEGATION(S):
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-Staff left resident in soiled clothing.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a complaint investigation and deliver findings regarding the above allegations and met with Licensee James Cox.

The Department received an allegation of staff left resident in soiled clothing. Per Reporting party, client (C1) has returned home from the day program in their own soiled clothing, which it has not been the first time that this incident has occurred. The reporting party was unaware of C1’s transportation arrangements. During the investigation, LPA conducted a 10-day visit to open the complaint and obtained pertinent documents. Based on records review, LPA obtained an incident report from C1’s residence indicating that on two occasions 10/18/23 and 11/15/23, C1 arrived home from Day Program with their clothes soiled. Group Home staff have contacted Day Program to discuss their lack of assistance with C1’s personal hygiene needs.
Continued on LIC9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024
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 2
Control Number 21-AS-20231120150114
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: BECOMING INDEPENDENT-SANTA ROSA
FACILITY NUMBER: 496801563
VISIT DATE: 01/22/2024
NARRATIVE
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Continued from LIC9099...

Responsible parties were notified, including the placement agency, about both incidents. After the second incident, all parties involved held meetings on 11/21/23 and 12/11/23 to discuss, address and follow up on the services provided to meet C1’s care needs, where it was agreed to implement a daily in-service schedule system, designated staff will assist C1 at the end of the day, pre-boarding check will be conducted by staff to ensure C1’s personal care support needs are met. Based on interviews conducted with witnesses and staff it was unclear to determine the specific moment that the incident happened due to the long ride time frame between Santa Rosa and Cloverdale commute that C1 travels every day. A finding that the complaint allegation staff left resident in soiled clothing is unsubstantiated meaning 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, therefore the allegation is UNSUBSTANTIATED.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2