496803944-9-4-2025-21-AS-VBEI-DLSQJ3-20250923121205

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803944
Report Date: 09/04/2025
Date Signed: 09/04/2025 11:35:36 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
06/20/2025 and conducted by Evaluator Robert Frank

COMPLAINT CONTROL NUMBER: 21-AS-20250620114840

FACILITY NAME:	UTULIVU HOME		FACILITY NUMBER:	496803944
ADMINISTRATOR:	JIMENEZ, NAYELY		FACILITY TYPE:	737
ADDRESS:	3610 WALLACE ROAD		TELEPHONE:	(707) 536-9483
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95404
CAPACITY:	3	CENSUS: 3	DATE:	09/04/2025
		UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Nayely Jimenez, Administrator		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Personal Rights
Lack of Food
Facility is not clean
Conduct Inimical

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Robert Frank arrived unannounced to deliver findings regarding the above allegations and met with facility Administrator Nayely Jimenez.

Complaint alleges that facility staff violate clients’ personal rights by using improper restraints and yelling at clients in care. A witness reported that a staff member grabbed the back of a client’s shirt to restrain them. During the investigation LPA interviewed eighteen (18) staff members. Staff members stated that there have been occasions where Ukeru Pads have been used, utilizing the Grafton/Ukeru restraint method to prevent clients from self-harm or harming others. Staff members stated the Ukeru pads are used as a last resort. The Grafton/Ukeru method, as well as the Pro-Act method (Professional Assault Crisis Training) are listed in the facilities Program Plan. A Witness reported that staff members speak rudely or in a belittling manor to clients in care.

Continued on 9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025

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 3

Control Number 21-AS-20250620114840

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: UTULIVU HOME	FACILITY NUMBER: 496803944
	VISIT DATE: 09/04/2025

NARRATIVE

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...Continued from 9099

During interviews staff members stated that they have not witnessed other staff members yelling or speaking to clients in care in a belittling manner. So, 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.

The complaint alleges that there is a lack of food at the facility. A witness stated that the Licensee, to finance outside business ventures, is inadequately supplying food for the facility. During unannounced facility complaint visits on 6/24/2025, 8/5/2025 and 8/22/2025 LPAs Frank (8/5/2025 & 8/22/2025) and Alviso (6/24/2025) inspected food supplies and observed that there were sufficient quantities of both perishable and non-perishable food on hand. Photos of food supplies were obtained on 6/24/2025 and 8/22/2025. During interviews, staff members stated that there is plenty of food and that they have not had to use their own money for the facility’s food items and that there are always sufficient food supplies at the facility. Staff members further stated that the facility shopping is consistently done on Tuesdays or Wednesdays. During the investigation LPA audited receipts of food purchased for the facility from March 2025 through June 2025. Food purchases during these months varied from $2500.00 to $3000.00. In an interview, Client C2 stated the food is very good at the facility and that they are taken out to eat on occasion. So, 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.

The complaint alleges that the facility is not clean. A witness stated that the facility is often not clean. The witness further stated the house is always cleaned when they know of a monitor coming to check on the facility. During facility complaint visits on 6/24/2025, 8/5/2025 and 8/22/2025 LPAs Frank (8/5/2025 & 8/22/2025) and Alviso (6/24/2025) LPAs observed the facility to be clean except for the ceiling fan screens in the clients’ two (2) bathrooms. During the facilities annual inspection on 5/29/2025, LPA did not observe any issues regarding facility sanitation. Facility staff members stated that the facility is cleaned several times a week or as needed. So, 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.

Continued on 9099-C2...

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 21-AS-20250620114840

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: UTULIVU HOME	FACILITY NUMBER: 496803944
	VISIT DATE: 09/04/2025

NARRATIVE

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...Continued from 9099-C

Complaint alleges that there is inimical conduct occurring at the facility. A witness reported that a staff member comes to work inebriated and that racism seems to be a pervasive problem amongst the staff. During LPA complaint inspections of the facility and of facility trash receptacles, there was no evidence of alcohol being consumed at the facility. During staff interviews, staff stated that they have never witnessed or were aware of any staff members coming to work inebriated or consuming alcoholic beverages at the facility. The staff were asked specific questions as to if they have ever heard racist remarks or if they have witnessed any client or staff members personal rights having been violated. All staff members stated that they have never witnessed, or heard of, any racist remarks or any comments that would constitute a violation of another staff members' or clients' personal rights. So, 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 during today's visit.

Exit interview conducted. Copy of report discussed and provided to Administrator Jimenez. Signature on form confirms receipt of documents.

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Robert Frank
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025

LIC9099 (FAS) - (06/04)

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