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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496803664
Report Date: 07/27/2023
Date Signed: 07/27/2023 10:10:14 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
06/30/2023 and conducted by Evaluator Victoria Bertozzi
COMPLAINT CONTROL NUMBER: 21-AS-20230630125230
FACILITY NAME:ERIC'S HOMEFACILITY NUMBER:
496803664
ADMINISTRATOR:JOHNSON-REED, MADISONFACILITY TYPE:
737
ADDRESS:1944 HIDDEN VALLEY DRIVETELEPHONE:
(707) 303-7961
CITY:SANTA ROSASTATE: CAZIP CODE:
95404
CAPACITY:4CENSUS: 4DATE:
07/27/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator, Madison Johnson-ReedTIME COMPLETED:
10:20 AM
ALLEGATION(S):
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Staff verbally abused resident in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst Bertozzi arrived unannounced to deliver findings regarding the above mentioned complaint allegation and met with Administrator, Madison Johnson-Reed.

Staff verbally abused resident in care – Complaint alleges that a facility staff was observed yelling at a resident while in the community. Multiple witnesses were interviewed and more than half indicated that the noted staff had space between them and the identified resident so did raise their voice to be heard but would not describe the staff as yelling.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Bertozzi
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
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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