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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 577003619
Report Date: 05/03/2024
Date Signed: 05/03/2024 02:53:32 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
04/18/2024 and conducted by Evaluator Jill Nakagawa
COMPLAINT CONTROL NUMBER: 21-AS-20240418110930
FACILITY NAME:SAFE HARBOR CRISIS HOUSE-YOLO COMMUNITY CAREFACILITY NUMBER:
577003619
ADMINISTRATOR:SHARONDA WATSONFACILITY TYPE:
772
ADDRESS:584 KENTUCKY AVENUETELEPHONE:
(530) 661-3213
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY:14CENSUS: 5DATE:
05/03/2024
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Sharonda Watson, AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff did not provide a safe environment for clients and other staff members
INVESTIGATION FINDINGS:
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On 05/03/2024, Licensing Program Analyst (LPA) Nakagawa arrived unannounced for the purpose of delivering complaint investigation findings and was greeted by Administrator, Sharonda Watson. LPA toured the facility, interviewed staff and outside parties, reviewed facility records and made observations during the course of the investigation.
Complaint alleges Staff did not provide a safe environment for clients and other staff members. LPA inspected the facility and found no obvious safety issues: exits and walkways were free from obstructions; the facility was a comfortable temperature, clean and odor free; bathrooms were clean and sanitary, with soap and paper towels available. Continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
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 2
Control Number 21-AS-20240418110930
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: SAFE HARBOR CRISIS HOUSE-YOLO COMMUNITY CARE
FACILITY NUMBER: 577003619
VISIT DATE: 05/03/2024
NARRATIVE
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Continued from 9099......

There was a satisfactory supply of linens and hygiene supplies for residents. There was also an ample supply of perishable and nonperishable food as required by Title 22, and water temperatures were within regulation.

LPA conducted interviews with 7 of 9 clients (C1-C7); no one stated to LPA that the actions of staff members create an unsafe environment. Clients’ statements indicated satisfaction in the services and programs provided by the facility. LPA also conducted interviews with 6 of 6 staff members (S1- S6) none of which stated that they felt staff have caused an unsafe environment due to staff being unresponsive or not responding to safety issues timely. In addition, clients and staff did not disclose to LPA that they are threatened by staff. Due to contradicting information provided by complainant and a lack of corroborating evidence, the allegation is found to be unsubstantiated.

A finding that the complaint allegations, Staff did not provide a safe environment for clients and other staff members 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 allegation is UNSUBSTANTIATED.


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

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
LIC9099 (FAS) - (06/04)
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