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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496804239
Report Date: 04/15/2025
Date Signed: 04/15/2025 12:05:06 PM

Unfounded


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
01/30/2025 and conducted by Evaluator Dina Alviso
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20250130095032
FACILITY NAME:BLUEBELL MANORFACILITY NUMBER:
496804239
ADMINISTRATOR:SOLOMON BANAFACILITY TYPE:
740
ADDRESS:1997 BLUEBELL DRIVETELEPHONE:
(707) 800-2522
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY:6CENSUS: 6DATE:
04/15/2025
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Liza Fonseca-Lead CaregiverTIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not have proper training
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Alviso conducted a complaint inspection, 4/15/25 at approximately 10:20am, and met with Lead staff Liza Fonseca. Lead staff Fomseca has a current RCFE administrator certificate.

LPA reviewed staff records and obtained copies as requested.

Reporting party alleges that the facility “staff do not have proper training”. LPA reviewed staff training records for six (6) staff (S2, S3, S4, S5, S6, S7) that were on the regular work schedule. Per record reviews, all six (6) staff have required trainings. There was no information obtained during this investigation to support a violation had occurred regarding reported allegation.

Based on record reviews, interviews, and related information obtained during the investigation, the allegation “staff do not have proper training”, we have found that the complaint allegation is Unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
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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