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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455002759
Report Date: 11/27/2023
Date Signed: 11/27/2023 09:19:54 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/29/2023 and conducted by Evaluator Donna Gurriere
COMPLAINT CONTROL NUMBER: 59-AS-20230929161811
FACILITY NAME:CRAFTSMAN HOUSE, INC.FACILITY NUMBER:
455002759
ADMINISTRATOR:OSTERMAN, DORISFACILITY TYPE:
735
ADDRESS:3716 CRAFTSMAN AVE.TELEPHONE:
(530) 262-5002
CITY:SHASTA LAKESTATE: CAZIP CODE:
96019
CAPACITY:6CENSUS: 1DATE:
11/27/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:BRITTANY HENRYTIME COMPLETED:
09:30 AM
ALLEGATION(S):
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The administrator raises her voice when talking to staff in front of the residents.
A resident self-harms herself for attention. Staff are not providing adequate care and supervision.
INVESTIGATION FINDINGS:
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On 11/27/23 Donna Gurriere, Licensing Program Analyst (LPA) arrived at the facility unannounced to deliver final findings regarding a complaint that was received on 09/29/23. LPA Gurriere met with Brittany Henry, Care Provider and explained the purpose of the visit.

The administrator raises her voice when talking to staff in front of the residents.

During the interview process, the licensee, the administrator and two staff persons were interviewed. Documents were received and reviewed to include the Individual Program Plan (IPP), the admission agreement, medical/dental care record, and the facility resident's charting logs.



continued
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Donna Gurriere
LICENSING EVALUATOR SIGNATURE:

DATE: 11/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023
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 59-AS-20230929161811
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: CRAFTSMAN HOUSE, INC.
FACILITY NUMBER: 455002759
VISIT DATE: 11/27/2023
NARRATIVE
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continued

During the investigative process, all persons involved were interviewed and reported that they have never heard the administrator raise her voice in front of the residents or even raise her voice at all. It was reported that the administrator is considered a very “laid back” person.

A resident self-harms herself for attention. Staff are not providing adequate care and supervision.

During the interview process, the licensee, the administrator and two staff persons were interviewed. Documents were received and reviewed to include the Individual Program Plan (IPP), the admission agreement, medical/dental care record, and the facility resident charting logs.

During the investigative process, it was reported by staff that for the most part, the resident (Resident 1) does not self-harm herself. It was stated by one person that on one occasion, the resident poked her arm with an earring tip; however, there was no injury, and it was not considered “self-harm.” The resident’s daily log and the IPP were reviewed, and those documents did not indicate that the resident self-harms herself. Staff reported that overall, the resident does like to visit with staff members; however, it was stated that the resident does not self-harm for attention.

Although the above allegations mentioned may have happened, or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are Unsubstantiated.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Donna Gurriere
LICENSING EVALUATOR SIGNATURE:

DATE: 11/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2