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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486801529
Report Date: 01/30/2024
Date Signed: 01/30/2024 11:21:32 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 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
12/14/2023 and conducted by Evaluator Christi Coppo
COMPLAINT CONTROL NUMBER: 21-AS-20231214092330
FACILITY NAME:FAIRFIELD MEADOWSFACILITY NUMBER:
486801529
ADMINISTRATOR:SALVADOR, MARIAFACILITY TYPE:
740
ADDRESS:4526 TOLENAS AVENUETELEPHONE:
(707) 422-2511
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:6CENSUS: 6DATE:
01/30/2024
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Chet Salavador, Admin TIME COMPLETED:
11:36 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff member pushed the resident agressively
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At approximately 10;00am, Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to deliver findings regarding the above allegation and met with Chet Salvador, Administrator.

Complaint alleges staff member pushed the resident aggressively. Per interviews conducted, resident revealed to Reporting Party that the staff at Fairfield Meadows pushed and bullied a client. During the most recent incident, staff yelled and pushed noted resident, resulting in resident hitting the wall. Per interviews conducted, outside parties and witnesses have never observed the staff being aggressive with residents or yelling at residents. Per LPA’s interview with noted resident, staff is aggressive with them, sometimes hitting them. Per LPA’s interview with witness, it has been reported that staff has been aggressive with a resident. However, staff being aggressive has not been directly observed.

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.No deficiencies cited during this inspection.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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