216803245-9-11-2024-21-AS-VBEI-D96PKG-20240916112304

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 216803245
Report Date: 09/11/2024
Date Signed: 09/11/2024 11:50:57 AM

Unsubstantiated

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
07/25/2024 and conducted by Evaluator Caitlynn Felias

COMPLAINT CONTROL NUMBER: 21-AS-20240725135450

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: 3	DATE:	09/11/2024
		UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Staff Member, Faye Canete, and Designated Representative, Stephanie Ellazar		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff left resident soiled for an extended period
Staff do not provide residents with adequate food service

INVESTIGATION FINDINGS:

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At approximately 11:20AM, Licensing Program Analyst (LPA) Felias arrived unannounced to deliver findings for this Complaint Investigation regarding the above allegations and met with Staff Member, Faye Canete. Designated Representative, Stephanie Ellazar, arrived during visit at approximately 11:30AM.

During the course of the investigation, the Department requested and reviewed documents, conducted interviews, and made observations. There is an allegation that “Staff left resident soiled for an extended period” and “staff do not provide residents with adequate food service.” Complainant alleged the following: residents are not changed at night, there is a lack of food supply and dietary needs are not followed. LPA contacted the Complainant for more details but did not receive new information. During visit conducted on 07/31/2024 and 09/11/2024, LPA observed that facility had enough food per Title 22 Regulations.

Continued on LIC9099C

Unsubstantiated

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: 09/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024

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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Control Number 21-AS-20240725135450

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: 09/11/2024

NARRATIVE

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Continued from LIC9099

Interviews conducted with involved parties stated they did not have any concerns regarding the quality of food or meals given at the facility. Document review showed that all residents in the facility have a regular diet with no dietary restrictions. Interview conducted with facility staff stated that residents are changed and repositioned every 2-4 hours or as needed. Interviews with involved parties stated that they had no concerns with the incontinence care being provided at the facility. During visit conducted on 09/11/2024, LPA observed facility staff assisting residents with incontinence care and did not observe any foul odors.
Police report dated 07/25/2024 stated that a visit was conducted by the San Rafael Police Department. Per their observations, all residents in the facility looked to be in good health, had no complaints of mistreatment, and the facility had plenty of food available.

Based on document review, interviews conducted, and observations made, the allegations of “staff left resident soiled for an extended period” and “staff do not provide residents with adequate food service,” are Unsubstantiated.

A finding that the complaint allegation is Unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

No Deficiencies Cited during visit.

Exit interview conducted. Copy of report discussed and provided to Designated Representative. 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: 09/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024

LIC9099 (FAS) - (06/04)

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