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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 286804030
Report Date: 08/20/2024
Date Signed: 08/20/2024 01:28:43 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
04/19/2024 and conducted by Evaluator David Leibert
COMPLAINT CONTROL NUMBER: 21-AS-20240419124724
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: 18DATE:
08/20/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Babita DhawanTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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9
Staff handled residents in a rough manner
Staff left residents in wet briefs for extended periods of time
Staff bathed resident with cold water
Staff overmedicated residents
INVESTIGATION FINDINGS:
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2
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5
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13
Licensing Program Analyst Leibert arrived unannounced for the purpose of delivering findings on this complaint. During the course of this investigation Staff, residents and persons responsible for the residents were interviewed. Four unannounced site visits were conducted and pertinent documents obtained and reviewed. The following determinations are made: No evidence of medication errors or abuse of residents was found; The "Incontinent Care & Toileting Residential Documentation logs for a 60 day period before and after receipt of the complaint indicate residents were checked and changed appropriately; Three of the four showers on site are functioning properly with hot water; All family members with residents in care that were interviewed have indicated satisfaction with the care provided; The Hospice nurses notes for the two Hospice patients interviewed indicate no abuse and good care being provided by staff. Although the allegations may be true, based on statements and documents, there is not a preponderance of evidence to prove or, disprove, the allegations. Therefore, the allegations are found to be UNSUBSTANTIATED.
No citations issued today.
Report left.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: David LeibertTELEPHONE: (707) 588-5086
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
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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