<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 572700610
Report Date: 06/09/2023
Date Signed: 06/29/2023 05:21:50 PM

Substantiated


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
06/06/2023 and conducted by Evaluator Jill Nakagawa
COMPLAINT CONTROL NUMBER: 21-AS-20230606140504
FACILITY NAME:WOODLAND COMMUNITY OPTIONSFACILITY NUMBER:
572700610
ADMINISTRATOR:PEFLEY, SHELLYFACILITY TYPE:
775
ADDRESS:45 W COURT STREETTELEPHONE:
(916) 283-8302
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY:50CENSUS: 31DATE:
06/09/2023
UNANNOUNCEDTIME BEGAN:
10:38 AM
MET WITH:Sara Heringer, Program ManagerTIME COMPLETED:
10:39 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Illegal Eviction
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 06/09/2023 Licensing Program Analyst (LPA) Jill Nakagawa conducted a complaint investigation regarding the allegation listed above. LPA arrived unannounced on this day for the purpose of delivering findings of the above allegation. LPA met with Sara Heringer, Program Manager.

The complainant alleges that Woodland Community Options inappropriately served an eviction letter ceasing program services for C1. The eviction letter was issued on 5/8/2023, indicating program services ending for C1 on 6/8/2023.

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

DATE: 06/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023
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-20230606140504
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: WOODLAND COMMUNITY OPTIONS
FACILITY NUMBER: 572700610
VISIT DATE: 06/09/2023
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

RP stated that the facility is fabricating incidents claiming that the RP is inappropriate or rude to the facility staff. In addition, RP stated that the reasonings for the eviction are invalid and have nothing to do with C1's behavior or compatability with the day program. RP informed LPA that the facility is evicting/removing C1's enrolled day program services unlawfully. LPA reviewed documents, made observations and conducted interviews and found the allegation to be substantiated as the Program Discharge (Eviction) fails to disclose how the program does not meet C1's needs. Therefore this allegation is SUBSTANTIATED.

A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. California Code of Regulations, (Title 22, Division 6, Chapter 3 and the Health and Safety Code), are being cited on the attached LIC 9099D.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 21-AS-20230606140504
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: WOODLAND COMMUNITY OPTIONS
FACILITY NUMBER: 572700610
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/09/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/09/2023
Section Cited
CCR
82068.5(a)
1
2
3
4
5
6
7
82068.5Procedures for Discharge:(a)A minimum of two weeks' notice given to a client... must be discharged from the day program. This require
1
2
3
4
5
6
7
Administrator agrees to provide clients a minimum of two weeks' notice to a client and his/her family and care providers that clearly
8
9
10
11
12
13
14
 requirement is not met as evidenced by:Based on review of records, Administrator fails to disclose how program does not meet C1's needs which poses a potential health and safety risk to clients in care.
8
9
10
11
12
13
14
states the program can no longer meet the needs of the client, and he/she must be discharged from the day program and provide a copy to CCL at the time of submission to client and RP.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3