286804030-4-26-2024-21-AS-VBEI-D4WQ9E-20240503115810

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 286804030
Report Date: 04/26/2024
Date Signed: 04/26/2024 01:11:05 PM

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
01/25/2024 and conducted by Evaluator Helena Rummonds

COMPLAINT CONTROL NUMBER: 21-AS-20240125155602

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: 22	DATE:	04/26/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator, Babita Dhawan		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff did not treat resident with dignity and respect.
Staff interfered with resident’s visits.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Helena Rummonds arrived unannounced at approximately 9:30AM to deliver findings regarding the above allegations. LPA was greeted by staff, and Administrator, Babita Dhawan arrived shortly after. LPA and Administrator discussed the purpose of the visit.

Throughout the course of the investigation, LPA conducted interviews, made observations, and reviewed documents.

Complaint alleges that staff did not treat resident with dignity and respect. Residents interviewed indicated that they are treated well at the facility. Staff interviewed indicated that they have not witnessed other staff treating residents poorly.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Helena Rummonds	TELEPHONE: (707) 588-5057
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024

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-20240125155602

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: BERKSHIRE, THE	FACILITY NUMBER: 286804030
	VISIT DATE: 04/26/2024

NARRATIVE

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Continued from LIC9099

Complaint alleges that staff interfered with resident’s visits. Residents interviewed indicated that they have not had staff interfere with their visits. Staff interviewed stated that they do have recommended visitation hours, and they try to encourage visitors to not come during mealtimes. However, they do not monitor or interfere with visitation.

Interviews revealed that there is one resident (Resident 1, R1) who cannot have two specific individuals visit due to a restraining order that was filed against them. Documentation reviewed revealed that the restrained persons shall not contact the individual directly or indirectly, in any way, including but not limited to: in person, by telephone, in writing, by public or private mail, by interoffice mail, by email, by text message, by fax, or by other electronic means. Staff interviews indicated that R1 still had visitors, but staff encouraged those visitors not to use their phone with R1 present in order to mitigate indirect contact from those restrained from R1.

Based on interviews conducted and observations made, and while the allegation may be valid, there is not a preponderance of evidence to prove the alleged violations did, or did not, occur. Therefore, the allegations are UNSUBSTANTIATED.

SUPERVISOR'S NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Helena Rummonds	TELEPHONE: (707) 588-5057
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024

LIC9099 (FAS) - (06/04)

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