496801932-2-27-2026-21-AS-VBEI-DRTV8C-20260303151230

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496801932
Report Date: 02/27/2026
Date Signed: 02/27/2026 09:03:50 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
01/02/2026 and conducted by Evaluator Robert Frank

COMPLAINT CONTROL NUMBER: 21-AS-20260102113308

FACILITY NAME:	DUNGARVIN CALIFORNIA LLC		FACILITY NUMBER:	496801932
ADMINISTRATOR:	FAIRCHILD, CARRIE		FACILITY TYPE:	775
ADDRESS:	433-439 BEAVER ST		TELEPHONE:	(707) 543-5895
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95404
CAPACITY:	75	CENSUS: 44	DATE:	02/27/2026
		UNANNOUNCED	TIME BEGAN:	08:25 AM
MET WITH:	April Supple, Program Director		TIME COMPLETED:	09:15 AM

ALLEGATION(S):

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Staff did not provide adequate supervision resulting in clients engaging in inappropriate behavior.

INVESTIGATION FINDINGS:

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At approximately 8:25 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to deliver Complaint findings regarding the above allegations and met with Program Director (PD) April Supple.

During the course of the investigation LPA conducted a facility visit, conducted interviews, collected and reviewed documents.

Complaint alleges Staff did not provide adequate supervision resulting in clients engaging in inappropriate behavior. On December 30th, 2025, at approximately 8:50 AM clients were arriving to the day program. There were approximately 8 clients in the room during the incident. There were two (2) staff members present as well as additional staff members coming to take the clients to their various classrooms. During this time client C2 acted inappropriately towards client C1.

Continued on 9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2026

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-20260102113308

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: DUNGARVIN CALIFORNIA LLC	FACILITY NUMBER: 496801932
	VISIT DATE: 02/27/2026

NARRATIVE

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...Continued from 9099

Staff immediately intervened and moved the clients away from each other. The facility filed a Special Incident Report with Community Care Licensing (CCL), Adult Protective Services (APS) and North Bay Regional Center (NBRC). The facility immediately notified the Santa Rosa Police Department. LPA requested and received an unredacted copy of the Santa Rosa Police Department Incident/Investigation Report #SR250013916.0. In the report, the investigating officer noted, “Based on the information provided, the cognitive and developmental limitations of both involved parties, the lack of prior incidents and the absence of ongoing risk, no criminal charges will be pursued at this time”. Risk Management Assessment and Plan for client C2 did not indicate any previous or similar incidents that would suggest that C2 could potentially put other clients at risk. In an interview with witness W1, LPA was told that client C2 had in the past displayed a similar behavior to what occurred on 12/30/2025. This behavioral history was not shared with the facility or with the Regional Center. Facility staff member S1 stated in an interview that had they had known of his previous history, precautions would have been initiated to ensure the safety and well-being of the other clients. 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.

No deficiencies cited during today's visit.

Exit interview conducted. Copy of LIC-9099, LIC-9099C discussed and provided to PD Supple. Signature on form confirms receipt of documents.

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2026

LIC9099 (FAS) - (06/04)

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