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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 570301295
Report Date: 01/03/2024
Date Signed: 01/11/2024 09:14:14 AM

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
12/04/2023 and conducted by Evaluator Jill Nakagawa
COMPLAINT CONTROL NUMBER: 21-AS-20231204090313
FACILITY NAME:SUMMER HOUSE INC.FACILITY NUMBER:
570301295
ADMINISTRATOR:YOUNG, SAMANTHAFACILITY TYPE:
735
ADDRESS:206 5TH STTELEPHONE:
(530) 662-8493
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY:12CENSUS: 11DATE:
01/03/2024
UNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Sam Young, AdministratorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Personal rights
Staff did not safeguard residents personal belongings
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced at Summer House on 01/03/2024 to continue a complaint investigation and deliver findings.

LPA was granted entry by staff member Krista Key.
LPA conducted interviews, reviewed documents and made observations.

Continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024
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-20231204090313
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: SUMMER HOUSE INC.
FACILITY NUMBER: 570301295
VISIT DATE: 01/03/2024
NARRATIVE
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Continued from 9099

Allegations of “Personal rights” and “Staff did not safeguard residents’ personal belongings” were investigated.

The complaint alleges Personal Rights were violated when staff member ( S1) denied a resident (R1) the right to buy and drink their favorite beverage as a punishment for taking another resident’s drink without asking. LPA interviewed staff and residents and found that statement to be false. It is true that R1 borrowed a beverage from another resident without asking, however it is incorrect that R1 was repeatedly verbally punished for this action or denied the right to enjoy their favorite beverage. LPA conducted interviews and found that S1 discussed the situation with R1 and the issue was resolved by R1 replacing the borrowed items (beverages). The complaint states that it was unfair that the resident was required to buy a whole case of the item when they only took 3; but the item can only be purchased by the case. R1 expressed their understanding and stated that they were satisfied with the resolution as R1 would get to keep the additional beverages for their own enjoyment. The Department has investigated the complaint


alleging “Personal Rights” were violated and have found that the complaint
to be Unsubstantiated.




Continued on 9099-C(2)
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 21-AS-20231204090313
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: SUMMER HOUSE INC.
FACILITY NUMBER: 570301295
VISIT DATE: 01/03/2024
NARRATIVE
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Continued from 9099-C

The complaint alleges that Staff did not safeguard residents’ personal belongings. LPA conducted interviews, made observations and reviewed documents. House rules include policies which help to safeguard residents’ belongings. Also, residents’ personal belongings stored in the kitchen are within line of sight of staff and residents. Therefore, the allegation that staff did not safeguard residents’ personal belongings is unsubstantiated.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated.







SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3