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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496804140
Report Date: 03/17/2025
Date Signed: 03/20/2025 12:08:56 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
03/07/2025 and conducted by Evaluator Christi Coppo
COMPLAINT CONTROL NUMBER: 21-AS-20250307140033
FACILITY NAME:FREMONT HOUSEFACILITY NUMBER:
496804140
ADMINISTRATOR:THOMAS, DOMONIQUEFACILITY TYPE:
735
ADDRESS:2120 FREMONT DRTELEPHONE:
(707) 542-1595
CITY:SANTA ROSASTATE: CAZIP CODE:
95409
CAPACITY:6CENSUS: 4DATE:
03/17/2025
UNANNOUNCEDTIME BEGAN:
08:58 AM
MET WITH:Domonique Thomas, AdministratorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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**amended to remove substantiated allegations**
Staff left clients unattended
Facility is not sanitary
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christi Coppo arrived unannounced at this facility to open a complaint investigation into the above allegations. LPA met with Administrator Domonique Thomas.

LPA conducted interviews, made observations, and requested copies of documents.

Complaint alleges staff left clients unattended. Based on interviews and record review LPA is unable to determine if residents were left alone at prior dates. 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.

Complaint alleges facility is not sanitary. Complainant alleges facility bathroom has mold.

Continued on 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025
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 5
Control Number 21-AS-20250307140033
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: FREMONT HOUSE
FACILITY NUMBER: 496804140
VISIT DATE: 03/17/2025
NARRATIVE
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Continued from 9099...

During investigation, LPA toured facility and found it to be clean and sanitary. No black substances in the main bathroom or in the shower. Bath mat looked to be clean as well. Facility has master bedroom that resident occupies. LPA observed master bath to be clean and free from any black substances. 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.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
03/07/2025 and conducted by Evaluator Christi Coppo
COMPLAINT CONTROL NUMBER: 21-AS-20250307140033

FACILITY NAME:FREMONT HOUSEFACILITY NUMBER:
496804140
ADMINISTRATOR:THOMAS, DOMONIQUEFACILITY TYPE:
735
ADDRESS:2120 FREMONT DRTELEPHONE:
(707) 542-1595
CITY:SANTA ROSASTATE: CAZIP CODE:
95409
CAPACITY:6CENSUS: 4DATE:
03/17/2025
UNANNOUNCEDTIME BEGAN:
08:58 AM
MET WITH:Domonique Thomas, AdministratorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff did not provide adequate meals to clients in care
Personal Rights
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christi Coppo arrived unannounced at this facility to open a complaint investigation into the above allegations. LPA met with Administrator Domonique Thomas.

Complaint alleges staff did not provide adequate meals to clients in care. During investigation, LPA observed food present in the kitchen refrigerator and in the freezer in the garage. However, LPA did not observe enough food for four [4] residents to have enough food for 2 days of perishable and 7 days of non-perishable food. Admin advised she knows that food is looking low today and that she had planned to go grocery shopping today to re-stock. LPA advised that regulation requires food be in supply such that they have a 2 day supply of perishable and 7 day supply of non-perishable food on hand at any given time. Based on LPA’s observation and interview, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 Chapter 8, are being cited on the attached 9099D.

Continued on 9099A(C)...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 21-AS-20250307140033
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: FREMONT HOUSE
FACILITY NUMBER: 496804140
VISIT DATE: 03/17/2025
NARRATIVE
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Continued from 9099A...

Complaint alleges personal rights. Complaint alleges staff restricts hygiene products to residents in care. During investigation, LPA interviewed Admin. Admin reports that she is having issues with one resident (R1) when it comes to toilet paper. She states that R1 uses toilet paper in excess and that she has questioned them as to why they are using so much. Admin advised LPA that she has never denied R1 toilet paper only questioned them about it and limited the distribution of it. Admin advised LPA that Admin advised R1 they should only be using 2 rolls of toilet paper per week. Admin advised LPA that there is always toilet paper available to the residents in the bathroom. However, per LPA observation, there is no extra toilet paper in the main bathroom and the roll on the hook was almost gone. LPA asked Admin where extra toilet paper is and why it is not in the bathroom. Admin answered that she keeps the extra toilet paper out in the living room in the desk drawer. However, when LPA asked to see the extra toilet paper in the drawer there was not any present. Admin showed LPA marks on calendar for days on which R1 asked for more toilet paper, but marks were circles and LPA unable to identify the reason for the marks. LPA did observe Costco pack of toilet paper in the garage. LPA asked if residents have access to the garage and Admin advised only with the presence of staff as an escort. During investigation, LPA conducted interviews which revealed that toilet paper is not readily accessible and they must ask staff if they need it. Based on LPA interview the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 Chapter 8, are being cited on the attached 9099D.

Complaint alleges Admin and staff yell in front of the residents. During investigation, LPA learned that while Admin and husband lived at the facility they would yell and scream at each other while fighting. During investigation, LPA conducted interviews. Interviews confirm accounts of staff yelling in front of residents. Based on LPA interview the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 Chapter 8, are being cited on the attached 9099D. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Administrator. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.

Exit interview conducted with Administrator and a copy of this report was given.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 21-AS-20250307140033
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: FREMONT HOUSE
FACILITY NUMBER: 496804140
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/24/2025
Section Cited
CCR
80076(a)(1)
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80076 Food Services:(a)(1) In facilities providing meals to clients, the following shall apply: (1) All food shall be safe and of the quality and in the quantity necessary to meet the needs of the clients. Each meal shall meet at least 1/3 of the servings recommended in the USDA Basic Food
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Facility to submit a written plan that indicates how facility will ensure clients have access to the quantity and quality of food required by regulation. Additionally, the facility is to provide a menu for the upcoming week along with grocery receipts showing food items
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Group Plan...All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement is not met as evidenced by: Based on LPA observation and interviews, the licensee did not comply with the section cited above by not always ensuring the quantity of food required by regulation which poses a potential health, safety or personal rights risk to persons in care
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have been purchased related to the menu no later than POC due date, 3/21/25.
Type B
03/21/2025
Section Cited
CCR
80072(a)(2)
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80072 Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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Facility to conduct personals right training via the local ombudsman. Facility to find out next most current date of personal rights training conducted by Sonoma County ombudsman and report date to CCL no later than plan of correction due date of 3/21/25.
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This requirement is not met as evidenced by: Based on LPA observation and interviews, the licensee did not comply with the section cited above by in that staff yelled and argued in front of residents and staff restricts hygiene items to clients in care, which poses a potential health, safety or personal rights risk to persons in care
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Training class to be completed no later than 5/1/25.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5