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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 181300554
Report Date: 06/19/2023
Date Signed: 06/19/2023 04:00:20 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/13/2023 and conducted by Evaluator Kerry Hiratsuka
COMPLAINT CONTROL NUMBER: 25-AS-20230213111042
FACILITY NAME:REDWINE FAMILY HOMEFACILITY NUMBER:
181300554
ADMINISTRATOR:LINDEMAN, CARRIEFACILITY TYPE:
735
ADDRESS:461-905 REDWINE LANETELEPHONE:
(530) 253-3287
CITY:JANESVILLESTATE: CAZIP CODE:
96114
CAPACITY:6CENSUS: DATE:
06/19/2023
UNANNOUNCEDTIME BEGAN:
01:42 PM
MET WITH:Carrie LindemanTIME COMPLETED:
04:10 PM
ALLEGATION(S):
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Licensee failed to fingerprint her brother.
INVESTIGATION FINDINGS:
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LPA Hiratsuka, conducted this unannounced complaint visit. LPA met with Administrator/Licensee Carrie Lindeman.

LPA investigated the allegation above. LPA interviewed Administrator and reviewed the list of people who have criminal record clearance and are associated. Administrator stated her brother, who does not have criminal record clearance and is not associated supervised the residents a couple of times over the years by himself at the facility. She stated he has not done this for over a year. LPA advised to get him cleared and associated to the facility.

Based on the above, the allegation is substantiated.

Deficiencies cited from Title 22 Regulations and or the California Health and Safety Code. Failure to correct shall result in civil penalties. appeal rights left. Civil Penalties of $100.00 was issued today.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2023
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 4
Control Number 25-AS-20230213111042
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: REDWINE FAMILY HOME
FACILITY NUMBER: 181300554
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/20/2023
Section Cited
CCR
87355(e)(1)
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Criminal Record Clearance. All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department
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By 06/20/2023, Licensee shall submit in writing a written plan of correction ensuring all people who supervise the residents have criminal record clearance and be associated to the facility. Immediate civil penalties of $100.00 issued today.
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Licensee failed this as evidenced by: based on interview and review of clearances the brother of the licensee does not have criminal record clearance and was allowed to supervise the residents alone a couple of times. This poses an immediate risk to residents.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/13/2023 and conducted by Evaluator Kerry Hiratsuka
COMPLAINT CONTROL NUMBER: 25-AS-20230213111042

FACILITY NAME:REDWINE FAMILY HOMEFACILITY NUMBER:
181300554
ADMINISTRATOR:LINDEMAN, CARRIEFACILITY TYPE:
735
ADDRESS:461-905 REDWINE LANETELEPHONE:
(530) 253-3287
CITY:JANESVILLESTATE: CAZIP CODE:
96114
CAPACITY:6CENSUS: DATE:
06/19/2023
UNANNOUNCEDTIME BEGAN:
01:42 PM
MET WITH:Carrie LindemanTIME COMPLETED:
04:10 PM
ALLEGATION(S):
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Staff do not keep the facility clean and sanitary.
Facility Failed to submit Incident Report to the Department.
INVESTIGATION FINDINGS:
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LPA Hiratsuka, conducted this unannounced complaint visit. LPA met with Licensee/Administrator Carrie Lindeman.

LPA investigated the allegation above. LPA toured the facility and interviewed Licensee and attempted to interview residents.

LPA also interviewed Complainant and a couple of witnesses. LPA did not observe anything that could be deemed unsanitary. LPA observed the residents to be clean and the witnesses stated they have not observed the residents dirty. Complainant stated the facility had throw rugs that had feces smashed into them and some of the floor during the winter time. Licensee stated that was not true. LPA did not observe any fecal matter on the floor nor any throw rugs.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 25-AS-20230213111042
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME: REDWINE FAMILY HOME
FACILITY NUMBER: 181300554
VISIT DATE: 06/19/2023
NARRATIVE
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Licensee stated the incident report in question was a resident went to the doctor for a routine appointment and was sent to get a test done and it was negative and the doctor's appointment was fine. This does not impact the resident's health and well-being because the test was negative and the resident was fine. Based on that information the incident is not required to be reported to Community Care Licensing. No other people who live in the house were affected. Licensee does not remember anything else that could have occurred. LPA was not able to get more specifics about the incident.

Due to the information gathered, LPA cannot determine if the facility was dirty and unsanitary and if there was an incident that required to be reported. LPA finds allegations to be unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are unsubstantiated.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4