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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496803428
Report Date: 01/04/2024
Date Signed: 01/26/2024 10:31:31 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
09/05/2023 and conducted by Evaluator Cheyenne McCambridge
PUBLIC
COMPLAINT CONTROL NUMBER: 21-CR-20230905113837
FACILITY NAME:MUIR WOOD LLC - SKILLMAN SOUTHFACILITY NUMBER:
496803428
ADMINISTRATOR:SOWLE, SCOTTFACILITY TYPE:
730
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:10CENSUS: DATE:
01/04/2024
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Penn ChourreTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff violated client's personal rights
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On the above date, Licensing Program Analyst (LPA) Cheyenne McCambridge met with Care Coordinator Manager Penn Chourre regarding a complaint investigation at the facility. The purpose of the inspection was to deliver the findings for the above allegation.

During the course of the investigation, LPA McCambridge conducted confidential interviews, reviewed records and documentation. Confidential interviews determined that staff followed and are following protocol and procedures.

This department has investigated the allegations, and although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the above allegations are true; therefore, the above allegations are unsubstantiated.
An exit interview was conducted with Care Coordinator Manager Penn Chourre and a copy of this report was sent to the facility.
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Isabel DiegoTELEPHONE: (408) -406-2326
LICENSING EVALUATOR NAME: Cheyenne McCambridgeTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
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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