Complaint Investigation Report

Staff immediately intervened and moved the clients away from each other. The facility filed a Special Incident Report with Community Care Licensing (CCL), Adult Protective Services (APS) and North Bay Regional Center (NBRC). The facility immediately notified the Santa Rosa Police Department. LPA requested and received an unredacted copy of the Santa Rosa Police Department Incident/Investigation Report #SR250013916.0. In the report, the investigating officer noted, “Based on the information provided, the cognitive and developmental limitations of both involved parties, the lack of prior incidents and the absence of ongoing risk, no criminal charges will be pursued at this time”. Risk Management Assessment and Plan for client C2 did not indicate any previous or similar incidents that would suggest that C2 could potentially put other clients at risk. In an interview with witness W1, LPA was told that client C2 had in the past displayed a similar behavior to what occurred on 12/30/2025. This behavioral history was not shared with the facility or with the Regional Center. Facility staff member S1 stated in an interview that had they had known of his previous history, precautions would have been initiated to ensure the safety and well-being of the other clients. So, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

No deficiencies cited during today's visit.

Exit interview conducted. Copy of LIC-9099, LIC-9099C discussed and provided to PD Supple. Signature on form confirms receipt of documents.