216803245-7-3-2024-21-AS-VBEI-D72TDE-20240710143812

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 216803245
Report Date: 07/03/2024
Date Signed: 07/03/2024 01:21:11 PM

Substantiated

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
07/02/2024 and conducted by Evaluator Caitlynn Felias

COMPLAINT CONTROL NUMBER: 21-AS-20240702154134

FACILITY NAME:	COMFORTING HANDS FOREVER,LLC		FACILITY NUMBER:	216803245
ADMINISTRATOR:	BIERKE, EVERDINAH		FACILITY TYPE:	740
ADDRESS:	73 GOLDEN HINDE BLVD		TELEPHONE:	(415) 479-1900
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94903
CAPACITY:	6	CENSUS: 4	DATE:	07/03/2024
		UNANNOUNCED	TIME BEGAN:	12:00 AM
MET WITH:	Administrator/Licensee, Everdinah Bierke		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not maintain a comfortable temperature in the facility for residents

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

At approximately 12:00PM, Licensing Program Analyst (LPA) Felias arrived unannounced to initiate a Complaint Investigation regarding the above allegation and met with Licensee/Administrator, Ever Bierke.

During the Investigation, LPA reviewed documents, conducted interviews, and made observations. There is an allegation that "Staff did not maintain a comfortable temperature in the facility for residents." Report received on 07/02/2024 stated that it was extremely hot inside the facility. Additional information provided stated that temperature readings within the home read between 101F and 102F. It was also stated that Facility staff were observed to be monitoring the residents and actively keeping them hydrated. Residents were observed to not be in distress or have symptoms of heat stroke. LPA conducted interview with Licensee. Per Licensee, the Ombudsman visited the facility yesterday and reported that the temperature inside the facility was 102F. Licensee also stated that the San Rafael Police Department visited the facility and did not observe any residents in distress.
Continued on LIC9099C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Caitlynn Felias	TELEPHONE: 707-588-5039
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024

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 3

Control Number 21-AS-20240702154134

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: COMFORTING HANDS FOREVER,LLC	FACILITY NUMBER: 216803245
	VISIT DATE: 07/03/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Continued from LIC9099

Licensee stated that the facility staff were monitoring the residents, providing the residents with water and Popsicles, and were wiping them down regularly with cold compresses to keep them cool. Licensee informed LPA that after the visit from the Ombudsman, they purchased two portable air conditioning units for the facility and contacted a vendor to install tint to the facility windows to help keep the heat out. Interview conducted with Licensee corroborated with information received by the Department.

During visit, LPA made the following observations:

Facility's thermostat read 78F.
Multiple fans were running in the facility
One of two air conditioning units was installed

Per Licensee, the second air conditioning unit is going to be installed today, 07/03/2024.

Based on document review, interviews conducted, and observations made, this allegation is Substantiated. A finding that the Complaint allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

**Based on LPA observations, the deficiency cited for regulation 87303(b)(2) is cleared during visit.**

Exit interview conducted. Copy of report, LIC9099D (Deficiency Page), Appeal Rights, and Plan of Corrections Letter discussed and provided to Licensee/Administrator. Signature on form confirms receipt of documents.

SUPERVISOR'S NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Caitlynn Felias	TELEPHONE: 707-588-5039
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 21-AS-20240702154134

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: COMFORTING HANDS FOREVER,LLC	FACILITY NUMBER: 216803245
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/03/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/13/2024 Section Cited CCR 87303(b)(2)	1 2 3 4 5 6 7	87303 Maintenance and Operation:(b) A comfortable temperature for residents shall be maintained at all times.(2)The facility shall cool rooms to a comfortable range, between 78 degrees F (26 degrees C)...	1 2 3 4 5 6 7	LPA observed that the facility temperature on 07/03/2024 was 78F. Facility purchased portable air conditioning units for the facility and contacted vendor to install window tint to help keep heat out of facility. Deficiency cleared during visit.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: based on document review, interviews conducted, and observations made, Licensee did not ensure that temperatures in the facility were within regulation. Facility temperatures were observed by Licensee to be 102 degrees on 07/02/2024.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Caitlynn Felias	TELEPHONE: 707-588-5039
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3