<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496803654
Report Date: 09/03/2021
Date Signed: 09/03/2021 02:48:36 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/30/2021 and conducted by Evaluator Victoria Willis
COMPLAINT CONTROL NUMBER: 21-AS-20210630111122
FACILITY NAME:HARSTAD HOUSEFACILITY NUMBER:
496803654
ADMINISTRATOR:LAND, AUDREYFACILITY TYPE:
772
ADDRESS:1120 GORDON LANETELEPHONE:
(707) 527-3249
CITY:SANTA ROSASTATE: CAZIP CODE:
95404
CAPACITY:10CENSUS: 8DATE:
09/03/2021
UNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Administrator, Audrey LandTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Unlawful eviction
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst Willis arrived unannounced to deliver findings regarding the above-mentioned complaint allegation and met with Audrey Land.

Complaint alleges that facility “kicked out” client leaving them on the street when they were supposed to care for them. Interviews and document review revealed that client, C1 threw a pillow at a staff prompting staff to discharge client to homelessness. Staff contacted the Crisis Stabilization Unit who agreed to admit client, but client refused to be admitted voluntarily. Client did not meet the requirements where police officers could detain client involuntarily. During intake, client signed the House Rules, Responsibilities and Expectations which states the clients must refrain from physical violence and if they do, they may be discharged from the program immediately. Additionally, on June 9, 2021, C1 signed a document agreeing to not engage in verbal or physical aggression. Interviews with staff and a review of the facility’s Plan of Operation showed that facility does not differentiate levels of violence.

Continued on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Willis
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2021
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-20210630111122
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: HARSTAD HOUSE
FACILITY NUMBER: 496803654
VISIT DATE: 09/03/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Continued from LIC9099

A finding that the complaint allegation, that a client was unlawfully evicted, was unsubstantiated meaning that although the allegation may have happened there is not a preponderance of evidence to prove that the allegation occurred. We have therefore dismissed the complaint.

No deficiencies cited during this inspection
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Willis
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2