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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496803825
Report Date: 05/04/2022
Date Signed: 05/04/2022 02:01:38 PM

Unfounded


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
04/25/2022 and conducted by Evaluator Victoria Willis
COMPLAINT CONTROL NUMBER: 21-AS-20220425130618
FACILITY NAME:VINE RIDGE AT CLOVERDALEFACILITY NUMBER:
496803825
ADMINISTRATOR:UBALLEZ, DAVIDFACILITY TYPE:
740
ADDRESS:247 TREADWAY DRIVETELEPHONE:
(707) 791-4787
CITY:CLOVERDALESTATE: CAZIP CODE:
95425
CAPACITY:58CENSUS: 26DATE:
05/04/2022
UNANNOUNCEDTIME BEGAN:
11:31 AM
MET WITH:Licensee, Larona Farnum and Acting Administrator, Rachael LanhamTIME COMPLETED:
02:11 PM
ALLEGATION(S):
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9
Facility Administrator is not qualified due to not having an administrator certificate
INVESTIGATION FINDINGS:
1
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13
Licensing Program Analyst Willis arrived unannounced to conduct a complaint investigation regarding the above mentioned complaint allegation and met with Licensee, Larona Farnum and Acting Administrator, Rachael Lanham.

Complaint alleges that the facility does not have a certified administrator. Administrator, David Uballez has recently left this facility to work in another facility owned by the Licensee. Licensee is currently completing the Change of Administrator paperwork for the current Acting Administrator, Rachael Lanham who is currently working full time at the facility. Licensee is also working in the facility two days per week to assist in the transition. Acting Administrator and Licensee have active Administrator Certificates.

This agency has investigated the complaint alleging that facility Administrator is not qualified due to not having an administrator certificate. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Willis
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022
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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