496803807-10-5-2023-21-AS-VBEI-CYMU5H-20231218141647

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803807
Report Date: 10/05/2023
Date Signed: 10/05/2023 04:53:27 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, 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
07/28/2023 and conducted by Evaluator Dina Alviso

COMPLAINT CONTROL NUMBER: 21-AS-20230728081936

FACILITY NAME:	COGIR OF ROHNERT PARK		FACILITY NUMBER:	496803807
ADMINISTRATOR:	ACUMABIG, JOSE		FACILITY TYPE:	740
ADDRESS:	4855 SNYDER LANE		TELEPHONE:	(707) 585-7878
CITY:	ROHNERT PARK	STATE: CA	ZIP CODE:	94928
CAPACITY:	45	CENSUS:	DATE:	10/05/2023
		UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	Jose Acumabig-Administrator		TIME COMPLETED:	05:10 PM

ALLEGATION(S):

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Staff is consuming alcohol and marijuana during shift

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alviso conducted a complaint inspection, on 10/5/23 at approximately 2:10am, and met with the Administrator Jose Acumabig. LPA reviewed facility records, and five (5) staff files; All staff files had required records,including training records. LPA interviewed staff, S1, S2, S3, S4, S5, S7,and other related interested parties regarding the allegation. The investigation revealed that staff interviewed, by the LPA, denied observing any staff member drinking alcohol while on shift and/or smoking marijuana while on shift. Staff interviewed, by the LPA, all denied that they have drank alcohol and/or have smoked marijuana while on shift. The investigation revealed that there was differing information obtained from information provided to the Department regarding allegation. There was no information obtained that supported a violation had occurred.
Based on LPAs observations, record reviews, interviews with staff, and information obtained from other related party(s) there is insufficient information to prove or disprove the allegation of "Staff is consuming alcohol and marijuana during shift". 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. Exit interview conducted with Jose Acumabig, Administrator.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Dina Alviso	TELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

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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