286803790-2-1-2022-21-AS-BMOS-CBFQ8K-20220208105650

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 286803790
Report Date: 02/01/2022
Date Signed: 02/01/2022 11:19:29 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/01/2021 and conducted by Evaluator David Leibert

COMPLAINT CONTROL NUMBER: 21-AS-20211101134349

FACILITY NAME:	ROSE HAVEN LLC		FACILITY NUMBER:	286803790
ADMINISTRATOR:	FRANCO, RHON		FACILITY TYPE:	740
ADDRESS:	520 SANITARIUM RD		TELEPHONE:	(707) 963-3748
CITY:	ST HELENA	STATE: CA	ZIP CODE:	94574
CAPACITY:	32	CENSUS: 10	DATE:	02/01/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Rhon Franco		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Incontinence care needs not being met

INVESTIGATION FINDINGS:

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Licensing Program Analyst Leibert arrived unannounced for the purpose of delivering findings on the above captioned complaint. LPA met with Rhon Franco and discussed the findings. During the course of this investigation, statements were taken from witnesses and staff; documents were reviewed and obtained; site visits and observations made. The following determinations have been made: Staff claim to check residents for incontinence frequently; Care notes are inconsistently documented by staff; Recent site visit revealed a clean facility occupied by residents who were appropriately groomed and dressed; No offensive odors noted; Visiting medical personnel and resident family members report no issues with the incontinent care received by residents and generally praise the care provided by the staff. While the allegation may be true, or valid, based upon statements and observations, the preponderance of evidence standard has not been met. Therefore, the complaint is UNSUBSTANTIATED.

No citations issued today. Report left at facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Carla Martinez	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: David Leibert	TELEPHONE: (707) 588-5086
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2022

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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