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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 570303745
Report Date: 04/09/2024
Date Signed: 04/25/2024 02:26:10 PM

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
03/08/2024 and conducted by Evaluator Jill Nakagawa
COMPLAINT CONTROL NUMBER: 21-AS-20240308122445
FACILITY NAME:FARMHOUSE, THEFACILITY NUMBER:
570303745
ADMINISTRATOR:ASHLEY MURILLOFACILITY TYPE:
772
ADDRESS:24321 COUNTY ROAD 96TELEPHONE:
(530) 753-1653
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY:10CENSUS: 10DATE:
04/09/2024
UNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Romario Luckhoo, New AdministratorTIME COMPLETED:
04:50 PM
ALLEGATION(S):
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9
Staff providing drugs to clients
INVESTIGATION FINDINGS:
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13
On 04/09/2024, Licensing Program Analysts (LPAs) Nakagawa and Mutialu arrived unannounced for the purpose of continuing a complaint investigation and deliver findings on the above allegation.LPA's Nakagawa and Mutialu toured the facility, interviewed staff and clients, reviewed records and made observations during the course of the investigaton.
The complaint alleges that staff were providing drugs to clients in exchange for favors. LPAs conducted interviews with 5 of 10 clients (C1, C2, C3, C4, C5) and 5 of 13 staff (S1, S2, S3, S4, S5). LPAs found that none of the interviewees stated that they had any knowledge of staff providing drugs to clients. Continued on 9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024
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 2
Control Number 21-AS-20240308122445
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: FARMHOUSE, THE
FACILITY NUMBER: 570303745
VISIT DATE: 04/09/2024
NARRATIVE
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(Continued from 9099)

LPAs reviewed recent drug tests of residents and found no positive test results for 9 out of 9 clients.

Anonymous Complainant alleges staff were providing drugs to clients in exchange for favors; Complainant has not provided contact information and has not provided details which might identify possible dates and circumstances of drugs being provided to clients.

Due to a lack of corroborating evidence, the allegation is found to be unsubstantiated. A finding that the complaint allegation, Staff providing drugs to clients is unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation is UNSUBSTANTIATED.

No deficiency cited.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2