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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496801932
Report Date: 05/07/2026
Date Signed: 05/07/2026 09:36:22 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
02/10/2026 and conducted by Evaluator Robert Frank
COMPLAINT CONTROL NUMBER: 21-AS-20260210084851
FACILITY NAME:DUNGARVIN CALIFORNIA LLCFACILITY NUMBER:
496801932
ADMINISTRATOR:FAIRCHILD, CARRIEFACILITY TYPE:
775
ADDRESS:433-439 BEAVER STTELEPHONE:
(707) 543-5895
CITY:SANTA ROSASTATE: CAZIP CODE:
95404
CAPACITY:75CENSUS: 45DATE:
05/07/2026
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:April Supple, Program DirectorTIME COMPLETED:
09:45 AM
ALLEGATION(S):
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Client engaged in self-harm behavior due to staff neglect/lack of supervision
INVESTIGATION FINDINGS:
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At approximately 8:50 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to deliver findings regarding the above allegation and met with facility Program Director (PD) April Supple.

During the course of the investigation LPA conducted a facility visit, conducted interviews, collected and reviewed documents. Complaint alleges that Client (client C1) engaged in self-harm behavior due to staff neglect/lack of supervision. Witnesses W1 & W2 stated that on Monday, February 2nd between approximately 11:30 AM to 12:30 PM a group from Dungarvin California LLC arrived at a local park. Both W1 and W2 stated that they observed a Dungarvin client (C1) separating themselves from their group. The Dungarvin client C1 then proceeded to lay on the pavement in a fetal position, rocking and crying. Both witnesses W1 and W2 further stated that Dungarvin staff did not check on the well-being of the client. W1 and W2 said during this time Dungarvin client C1 engaged in self injurious behaviors.

Continued on 9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026
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-20260210084851
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: 05/07/2026
NARRATIVE
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...Continued from 9099

Both W1 & W2 stated that two (2) police officers arrived on the scene and that as client C1 saw the officers, they stopped engaging in self injurious behavior as they greeted the officers. Both W1 & W2 stated that after speaking with Dungarvin staff members, the officers departed. Both W1 & W2 both stated that Dungarvin client C1 shortly thereafter departed the park with the rest of the Dungarvin group having shown no signs of further self injurious behavior after the officers left the scene.

Dungarvin California LLC filed a Special Incident Report with Community Care Licensing (CCL) on Wednesday, February 4th as required by Title 22 Regulations. The report stated that during a visit to a local park, client C1 engaged in self injurious behavior. The report further states that staff attempted to redirect client C1 towards the program van; however, said attempts were unsuccessful. The report notes that once police officers arrived on the scene, client C1 stopped their self injurious behavior and greeted the officers. The report stated that once officers left the scene, client C1 boarded the program van to leave the park. Dungarvin staff members who accompanied the group to the park (staff members S1 & S2) provided statements synonymous with the facility’s Special Incident Report. Client C1 did not acquire any injuries as a result of their self injurious behavior. LPA requested an un-redacted police report from the local police department; however, there were no reports filed or calls to service on file for client C1 for the date of February 2nd, 2026. 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 LIC9099 and LIC9099-C 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: 05/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2