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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200380
Report Date: 07/17/2024
Date Signed: 07/17/2024 06:52:44 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/11/2024 and conducted by Evaluator Lori Alexander-Washington
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20240711093341
FACILITY NAME:ELISABETH CARE HOMEFACILITY NUMBER:
079200380
ADMINISTRATOR:OBED D'AUTRUCHEFACILITY TYPE:
740
ADDRESS:1612 N MARTA DRIVETELEPHONE:
(925) 471-0671
CITY:PLEASANT HILLSTATE: CAZIP CODE:
94523
CAPACITY:4CENSUS: 2DATE:
07/17/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Obed D'Autruche, AdministratorTIME COMPLETED:
07:15 PM
ALLEGATION(S):
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1. Facility staff are not keeping the facility at a comfortable temperature for
residents
INVESTIGATION FINDINGS:
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On 07/17/2024, at 11:30 am, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct complaint investigation visit for the above allegation. LPA met with Administrator, Obed D'Autruche and explained the reason for the visit. Licensee, Magdala D'Autruche, also was present at the facility.

Allegation: Facility staff are not keeping the facility at a comfortable temperature for residents
Unsubstantiated.

On 07/15/2024 LPA spoke with Reporting Party (RP) and they indicated that Staff 1 (S1) was not adhering to an mediated agreement between R1, W1 and S1 pertaining to the Central Air Conditioning (AC) and bedroom temperature for R1.

LIC9099-C Continued...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024
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 15-AS-20240711093341
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: ELISABETH CARE HOME
FACILITY NUMBER: 079200380
VISIT DATE: 07/17/2024
NARRATIVE
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LIC9099-C Continued...

LPA interviewed S1 that stated R1 wants the air to be cold and circulating all the time. S2 stated that R1 had a "private AC" but they took it out because it was expensive. S2 stated that R1's blinds are closed. S1 stated that on 07/09/2024 him and S2 were away from the facility but caregiver S3 was at the facility. S1 stated that he received a call from R1 regarding the temperature and that he spoke with S3. S1 stated that S3 said "...I don't know how to adjust the temperature..." S1 stated that he also spoke with his daughter, S4, who went and adjusted the temperature control. S1 stated when he returned back to the facility later that day, the temperature was good.

LPA interviewed R1 that stated on 07/09/2024 his room was hot during the excessive heat conditions during the last couple of weeks. R1 stated that S1 was gone from the facility with guests and that he called S1 3 times that day and no answer. R1 stated that they requested to S3 if they could turn the air temperature on but S3 refused. R1 stated "I need a lot of air." R1 stated that they had their own "Energy Efficient" personal AC that included a fan and humidifier which was installed by W2 in their bedroom. R1 stated after he was discharged and returned back from his last hospitalization, 05/21/24 thru 05/28/24, his personal AC was gone without any notice or explanation to why it was removed. R1 stated that his room is hotter than all the other rooms in the house, the location where his room is facing and that there is no cross ventilation in his bedroom.

Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation are UNSUBSTANTIATED.

Exit interview conducted and a copy of this report was provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024
LIC9099 (FAS) - (06/04)
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