286804030-6-29-2022-21-AS-KMOA-CG5NHW-20220708102921

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 286804030
Report Date: 06/29/2022
Date Signed: 06/29/2022 02:06:09 PM

Unsubstantiated

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
06/20/2022 and conducted by Evaluator Erik Gonzalez Campos

COMPLAINT CONTROL NUMBER: 21-AS-20220620102959

FACILITY NAME:	BERKSHIRE, THE		FACILITY NUMBER:	286804030
ADMINISTRATOR:	DHAWAN, BABITA		FACILITY TYPE:	740
ADDRESS:	2300 BROWN STREET		TELEPHONE:	(510) 996-8520
CITY:	NAPA	STATE: CA	ZIP CODE:	94558
CAPACITY:	72	CENSUS: 20	DATE:	06/29/2022
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Licensee/Administrator, Babita Dhawan		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Residents are being handled in a rough manner while in care.
Personal rights
Residents are not being fed while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Erik Gonzalez Campos arrived unannounced on 06/29/2022 to initiate a complaint investigation regarding the above allegations. LPA met with licensee/administrator, Babita Dhawan and Lia Miller.

During complaint inspection, LPA toured facility, reviewed records, and conducted interviews. Interviews with staff, residents and hospice nurse did not reveal any evidence of residents being handled in a rough manner while in care, residents not being fed while in care or personal rights violations. Although the allegations may be valid, there is not a preponderance of evidence to prove the alleged violations did, or did not occur. Therefore, the allegation is UNSUBSTANTIATED.

Exit interview conducted with Licensee/Administrator, Babita Dhawan and Lia Miller. A copy of this report was printed for the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Erik Gonzalez Campos	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022

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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