455002759-11-27-2023-59-AS-KHOS-CY3RRM-20231130121522

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 455002759
Report Date: 11/27/2023
Date Signed: 11/27/2023 09:18:22 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
09/22/2023 and conducted by Evaluator Donna Gurriere

COMPLAINT CONTROL NUMBER: 59-AS-20230922152649

FACILITY NAME:	CRAFTSMAN HOUSE, INC.		FACILITY NUMBER:	455002759
ADMINISTRATOR:	OSTERMAN, DORIS		FACILITY TYPE:	735
ADDRESS:	3716 CRAFTSMAN AVE.		TELEPHONE:	(530) 262-5002
CITY:	SHASTA LAKE	STATE: CA	ZIP CODE:	96019
CAPACITY:	6	CENSUS: 1	DATE:	11/27/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Brittany Henry		TIME COMPLETED:	09:30 AM

ALLEGATION(S):

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Facility did not ensure that a resident was provided supplies necessary for personal care and hygiene.
A resident has contagious head lice. Facility did not report as required.
Staff did not report an incident that happened at the day program with a resident.

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 09/22/23. LPA Gurriere met with Brittany Henry, Care Provider, and explained the purpose of the visit.

The facility did not ensure that a resident was provided supplies necessary for personal care and hygiene.

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.

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)

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Control Number 59-AS-20230922152649

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 investigation process, it was reported by the complainant that the resident (Resident 1) did not have soap available for her personal hygiene use. All staff reported that unless the resident threw her container away, there was and always is soap available. It was stated that the facility has large amounts of household supplies including soap for the residents. It was reported that the staff go to the Costco Store weekly to purchase items.

A resident has contagious head lice. Facility did not report as required.
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 logs.

During the investigation process it was reported by all staff that the resident did not in fact have head lice; however, had a bad case of dandruff. It was stated that a dandruff shampoo was bought for the resident and that she is using the shampoo. It was reported that there was nothing to report of the resident’s dandruff.

Staff did not report an incident that happened at the day program with a resident.
During the interview process, the licensee, the administrator, two staff persons and two residents were interviewed. In addition, three staff persons from the resident’s day program 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 logs.

During the investigation process, it was reported that an incident occurred at the day program in that a female resident from the facility went to her day program and it was alleged that a male resident brushed up against her breast. It is noted that the residents' consider themselves “friends, boyfriend and girlfriend.” Both residents were interviewed, and it was reported by the male resident that he went to give the female resident a hug and he “accidentally” touched the female resident’s breast. The female resident did not indicate that it was an issue. It was reported by staff later that night, at the resident’s home facility, that the residents’ spoke with one another as they usually do, and that the female resident did not act bothered or report anything unusual that happened at the day program. The allegation was an accidental incident that occurred at the day program, and staff were not required to report it.

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)

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