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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 286804030
Report Date: 11/04/2022
Date Signed: 11/04/2022 11:51:32 AM

Substantiated


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
11/02/2022 and conducted by Evaluator Erik Gonzalez Campos
COMPLAINT CONTROL NUMBER: 21-AS-20221102135915
FACILITY NAME:BERKSHIRE, THEFACILITY NUMBER:
286804030
ADMINISTRATOR:DHAWAN, BABITAFACILITY TYPE:
740
ADDRESS:2300 BROWN STREETTELEPHONE:
(510) 996-8520
CITY:NAPASTATE: CAZIP CODE:
94558
CAPACITY:72CENSUS: 21DATE:
11/04/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Licensee/Administrator, Babita DhawanTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility staff do not maintain a comfortable room temperature for residents in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Erik Gonzalez Campos arrived unannounced on 11/4/2022 at approximately 9:30 AM to conduct an initial complaint inspection regarding the allegation that facility staff do not maintain a comfortable room temperature for residents in care. LPA met with Licensee/Administrator Babita Dhawan.

Upon entering the facility into the main lobby LPA observed a thermostat reading 72 degrees which meets the regulation of a minimum of 68 degrees. Further into the facility LPA observed another thermostat which read 70 degrees which also meets the regulation of a minimum of 68 degrees. LPA observed a third thermostat which was reading 65 degrees which is not within regulation. The facility has space heaters available to heat resident rooms and a plan to fix heating issue in facility. LPA observed the thermostat with the low reading increase at the end of the inspection. The preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is being cited on the attached LIC 9099D. Appeal Rights Given. Exit interview conducted with licensee/administrator. Reports emailed to licensee.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Erik Gonzalez CamposTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022
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 2
Control Number 21-AS-20221102135915
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: BERKSHIRE, THE
FACILITY NUMBER: 286804030
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/11/2022
Section Cited
CCR
87303(b)(1)
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87303 Maintenance and Operation
(b) A comfortable temperature for residents shall be maintained at all times. (1) The facility shall heat rooms that residents occupy to a minimum of 68 degree F, (20 degrees C).
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Facility will ensure a plan is put in place to increase and maintain the temperature in the facility per regulation. Facility has already acquired space heaters for resident bedrooms. Facility plan to be submitted to Community Care Licensing by 11/11/2022.
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this requirement was not met as evidenced by: LPA observed an interior temperature reading of 65 degrees F during inspection on 11/04/2022 which poses a potential health and safety risk to residents in care.
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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.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Erik Gonzalez CamposTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2