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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496804127
Report Date: 02/06/2024
Date Signed: 02/06/2024 12:29:02 PM

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
01/30/2024 and conducted by Evaluator Christi Coppo
COMPLAINT CONTROL NUMBER: 21-AS-20240130094318
FACILITY NAME:DOUGLAS HOMEFACILITY NUMBER:
496804127
ADMINISTRATOR:HARRISON, THERESAFACILITY TYPE:
735
ADDRESS:350 BOAS DRTELEPHONE:
(707) 539-5351
CITY:SANTA ROSASTATE: CAZIP CODE:
95409
CAPACITY:6CENSUS: 3DATE:
02/06/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Theresa Harrison, AdministratorTIME COMPLETED:
12:43 PM
ALLEGATION(S):
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Facility smells of animal urine and feces
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a complaint investigation.

Facility smells of animal urine and feces - Complaint alleges that facility smells of animal urine and feces. Per LPA observation and tour of facility there are no odors of animal urine or feces. Facility has 4 dogs that are primarily outside during the day and come in to the facility to sleep at night. Dogs have crates in the living room and it smell like dogs but does not smell of animal urine or feces. Facility has 2 cats that live inside and never go outside. Facility has 2 litter boxes that were clean and free from cat urine and feces during LPA tour of faclity.

Based on LPA observation and inspection of facility, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2024
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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