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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 286804119
Report Date: 01/02/2024
Date Signed: 01/02/2024 11:51:08 AM

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
11/13/2023 and conducted by Evaluator David Leibert
COMPLAINT CONTROL NUMBER: 21-AS-20231113155356
FACILITY NAME:RAMEILS SACRED CARE HOMES 2FACILITY NUMBER:
286804119
ADMINISTRATOR:JEFFERSON, JENEROFACILITY TYPE:
735
ADDRESS:1513 RIO GRANDETELEPHONE:
(310) 531-6049
CITY:AMERICAN CANYONSTATE: CAZIP CODE:
95403
CAPACITY:6CENSUS: 5DATE:
01/02/2024
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Rowena RadanTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff did not seek timely medical care for client
Staff are not following modified diets
INVESTIGATION FINDINGS:
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Licensing Program Analyst Leibert arrives unannounced for the purpose of delivering findings on this complaint. During the course of this investigation, statements were taken from staff and witnesses, documents were obtained and reviewed as well as site visits made to the facility which included inspections of the kitchen and the food supply and service. Photo's of clients' lunches were obtained. The following determinations are made: Although one client appears to have a sensitivity to cheese, no client in care has a modified diet ordered by a physician or dietician; On 11/03/2023, client (C1) fell at day program and sustained an injury requiring medical intervention; On 11/01/2023, program staff notified facility that C1 was limping at program; Program staff allege that C1 continued to limp on 11/02 while at Program; Facility staff state they were not notified of the continuing limping by C1 and that C1 did not limp when at the facility prior to C1's fall. Although the allegations may be true, based on the statements and documents, there is not a preponderance of evidence to prove the allegations true or, not true. Therefore, the allegations are UNSUBSTANTIATED.
Report left.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carla Martinez
LICENSING EVALUATOR NAME: David Leibert
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2024
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 3
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
11/13/2023 and conducted by Evaluator David Leibert
COMPLAINT CONTROL NUMBER: 21-AS-20231113155356

FACILITY NAME:RAMEILS SACRED CARE HOMES 2FACILITY NUMBER:
286804119
ADMINISTRATOR:JEFFERSON, JENEROFACILITY TYPE:
735
ADDRESS:1513 RIO GRANDETELEPHONE:
(310) 531-6049
CITY:AMERICAN CANYONSTATE: CAZIP CODE:
95403
CAPACITY:6CENSUS: 5DATE:
01/02/2024
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Rowena RadanTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff failed to provide food in a safe and healthful manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst Leibert arrives unannounced for the purpose of delivering findings on this complaint. During the course of this investigation, statements were taken from staff and witnesses, documents were obtained and reviewed as well as site visits made to the facility which included inspections of the kitchen and the food supply and service. Photo's of clients' lunches were obtained. The following determinations are made: Two recent site visits to facility indicate a sufficient supply of fresh and non perishable stored in compliance with regulation; Day program staff reported the following to facility staff: 6/22/2023 - 2 clients with moldy sandwich bread in lunch; 8/01/2023 – 1 client sent to program with expired food; 11/10/2023 – 1 client found with a chicken bone in lunch. Based upon the statements made and the documents and photos reviewed, the preponderance of evidence standard has been met. Therefore, the allegation is SUBSTANTIATED. The following deficiencies were observed (see LIC 9099D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carla Martinez
LICENSING EVALUATOR NAME: David Leibert
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2024
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 3
Control Number 21-AS-20231113155356
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: RAMEILS SACRED CARE HOMES 2
FACILITY NUMBER: 286804119
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/05/2024
Section Cited
CCR
80076(a)(1)
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Food Services. In facilities providing meals to clients, the following shall apply:(1)All food shall be safe and of the quality and in the quantity necessary to meet the needs of the clients…Based on statements and documents, this requirement has not been met as
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Administration shall develop a plan to insure client lunches comply with Title Twenty – Two regulations. Written plan shall be submitted to CCL by POC date in order to clear the deficiency.
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evidenced by: Clients were sent to day program with moldy bread, expired food, and a chicken bone. This posed an immediate risk to the health of the clients.
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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.
SUPERVISORS NAME: Carla Martinez
LICENSING EVALUATOR NAME: David Leibert
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3