286804030-4-26-2024-21-AS-VBEI-D4ZUA7-20240506152416

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 286804030
Report Date: 04/26/2024
Date Signed: 04/26/2024 01:16:30 PM

Substantiated

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
02/16/2024 and conducted by Evaluator Helena Rummonds

COMPLAINT CONTROL NUMBER: 21-AS-20240216103748

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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Insufficient staffing
Food is not being served at appropriate temperature

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.

Complaint alleges there is insufficient staffing. Throughout the course of the investigation, LPA conducted interviews, made observations, and reviewed documents. Administrator and staff confirmed that there are multiple residents who require a two person assist. Based on document review, there is one staff on during night shift. Facility has a memory care unit as well as an assisted living unit. In order for staff to assist residents in one department, it requires them to leave residents in another department unattended. Based on document review and interview, facility does not have sufficient staffing to meet resident needs.

Continued on LIC9099-C

Substantiated

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)

Page: 1 of 5

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
02/16/2024 and conducted by Evaluator Helena Rummonds

COMPLAINT CONTROL NUMBER: 21-AS-20240216103748

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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Facility is not following activities calendar
Facility is not providing adequate laundry service

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 facility is not following activities calendar. Facility has a full time Activities Coordinator. LPA observed residents in Memory Care and Assisted Living engaged in the activities described on the activity calendar. Interviews conducted revealed that residents engage in activities when they have the desire to do so.

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)

Page: 2 of 5

Control Number 21-AS-20240216103748

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-A

Complaint alleges that facility is not providing adequate laundry service because items go missing and clean laundry still smells. LPA toured the facilities laundry room and observed the washer and dryer to be operational. LPA observed a drying rack to allow clothes to air dry. Interviews conducted revealed that residents drop off their laundry outside of their rooms and it is washed overnight. Interviews with residents revealed that 2 of 3 residents confirmed that their laundry has gone missing, however their laundry got switched with other residents of a similar name. Residents interviewed denied that their laundry was malodorous.

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 allegation is 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)

Page: 3 of 5

Control Number 21-AS-20240216103748

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 food is not being served at appropriate temperature. LPA observed facility to have electric warmers that meals are served out of. Staff confirmed that it is their procedure to preheat the warmers before mealtimes. Interviews conducted revealed that meals do not always come out hot, and that there has been a time when vegetables came out with frost still on them.

Based on documentation reviewed and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are cited from the California Code of Regulations (Title 22, Division 6). Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.

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)

Page: 4 of 5

Control Number 21-AS-20240216103748

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/26/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/03/2024 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs... This requirement has not been met as evidenced by:	1 2 3 4 5 6 7	Administrator agrees to submit self certification stating that they will hire an additional overnight staff by POC due date of 05/03/2024. Once an overnight staff is hired, proof of updated staff schedule to be provided to LPA.
	8 9 10 11 12 13 14	Based on document review, facility has one overnight staff despite having multiple residents who require a two person assist.	8 9 10 11 12 13 14
Type B 05/03/2024 Section Cited CCR 87555(a)	1 2 3 4 5 6 7	87555 General Food Service Requirements (a) ...All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement has not been met as evidenced by:	1 2 3 4 5 6 7	Administrator agrees to implement a system in which staff are ensuring that food warmers are operational and that food is cooked thoroughly before serving. Updated serving system to be provided to LPA by 05/03/2024.
	8 9 10 11 12 13 14	Based on observation and interview, food is served cold on occasion and there was a time when residents observed vegetables to have frost on them.	8 9 10 11 12 13 14

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: 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 appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024

LIC9099 (FAS) - (06/04)

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