570317743-5-13-2025-21-AS-KMOA-DGVSMT-20250521140028

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 570317743
Report Date: 05/13/2025
Date Signed: 05/13/2025 04:27:05 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
04/07/2025 and conducted by Evaluator Jill Nakagawa

COMPLAINT CONTROL NUMBER: 21-AS-20250407132923

FACILITY NAME:	DAVIS SUMMER HOUSE		FACILITY NUMBER:	570317743
ADMINISTRATOR:	STACY SHARP		FACILITY TYPE:	735
ADDRESS:	2525 EAST 8TH STREET		TELEPHONE:	(530) 757-1294
CITY:	DAVIS	STATE: CA	ZIP CODE:	95618
CAPACITY:	14	CENSUS: 12	DATE:	05/13/2025
		UNANNOUNCED	TIME BEGAN:	02:09 PM
MET WITH:	Stacy Sharp, Administrator		TIME COMPLETED:	04:25 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Licensee not ensuring client receives medical attention per physicians request
Licensee retaliating against clients

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Nakagawa arrived unannounced to continue a complaint investigation and to deliver findings. LPA spoke with Stacy Sharp, Administrator.
The complaint alleges that the Licensee does not ensure client receives medical attention per physician’s request. The reporting party stated that Staff (S1) did not call the physician or take Client (C1) to required medical appointments.
LPA’s review of medical records indicates that C1 and staff of Davis Summer House were in touch with physicians from the initial medical treatment of injury on 03/24/2025 and follow-up treatment was received on 03/28/2025, 04/2/2025 and 04/07/2025. C1’s condition was monitored with Zoom calls and in-person appointments with physicians facilitated by Davis Summer House.
Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025

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 2

Control Number 21-AS-20250407132923

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: DAVIS SUMMER HOUSE	FACILITY NUMBER: 570317743
	VISIT DATE: 05/13/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Continued from 9099....

At no time was C1 denied medical treatment as prescribed by physician. Therefore the allegation that Licensee does not ensure client receives medical attention per physician’s request is unsubstantiated.

The complaint alleges that the Licensee retaliates against clients. The reporting party stated that C1 repeatedly reported to outside parties that C1 was going to get in trouble for letting outside parties call Summer House trying to clarify the doctor's information from Staff (S2).

LPA reviewed the Release of Information forms in C1’s file. There is no release of information signed for outside parties who work with Davis Summer House to obtain clients medical information. Davis Summer House is prohibited by HIPAA to release information regarding their clients to unapproved parties. Therefore, the allegation that Licensee retaliates against clients is unsubstantiated.

Although the allegations may have happened or are 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: 05/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2