486800782-6-15-2020-21-AS-BMOS-BQQNKH-20200619103157

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486800782
Report Date: 06/15/2020
Date Signed: 06/15/2020 03:56:57 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/03/2020 and conducted by Evaluator Araceli Canela

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20200303083017

FACILITY NAME:	D HILLSIDE PLACE II		FACILITY NUMBER:	486800782
ADMINISTRATOR:	COPERO, JOHNNY		FACILITY TYPE:	740
ADDRESS:	103 MICHAEL CT.		TELEPHONE:	(707) 552-7584
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94591
CAPACITY:	6	CENSUS: 5	DATE:	06/15/2020
		UNANNOUNCED	TIME BEGAN:	01:43 PM
MET WITH:	Johnny Copero		TIME COMPLETED:	02:29 PM

ALLEGATION(S):

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Staff engaged into verbal altercations with residents.
Staff do not meet residents’ needs.

INVESTIGATION FINDINGS:

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The Department conducted a complaint investigation regarding the above captioned allegations. Licensing Program Analyst (LPA) A. Canela spoke with Licensee/Administrator, Johnny Copero, this date, for the purpose of delivering findings by phone due to the COVID – 19 precautions.

LPA previously reviewed records and received statements. It was alleged facility staff do not meet residents’ needs, more specifically, that the resident is not allowed to close the window shades in the living room and the sunlight coming in irritates R1's eyes. It was also alleged R1 was not allowed to continue to place his water cup on a piece of furniture near him as it may damage the furniture piece. Investigation revealed, the facility has always kept the blinds open to allow sunlight for all the residents in the home and did some seating changes to accommodate R1; moved the chair that R1 likes to sit in, so that the light would not affect him and R1 complained of the move.

Continue report see LIC9099-C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Araceli Canela	TELEPHONE: (707) 588-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2020

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 21-AS-20200303083017

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: D HILLSIDE PLACE II	FACILITY NUMBER: 486800782
	VISIT DATE: 06/15/2020

NARRATIVE

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It was also corroborated by staff and other residents in the home that the facility was trying to accommodate and work with R1's needs and the facility did not prevent R1 in putting his cup on the wood table, they asked R1 to put it on top of the coaster to protect the furniture. It was disclosed to LPA, the Ombudsman assisted R1 and the facility come to an agreement.

It was also alleged staff engaged into verbal altercations with residents. It was corroborated by residents and staff that there has not been verbal altercations from staff to R1 or any other residents living in the home. It was corroborated R1 has yelled at R2 and others residents in the home. Residents interviewed and R1 disclosed to LPA staff did not yell at them.

The Department has investigated the above allegations and have found that the complaint is UNFOUNDED, meaning that the allegations are false, could not have happened, and/or are without a reasonable basis. Therefore, the complaint is Dismissed.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Araceli Canela	TELEPHONE: (707) 588-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2020

LIC9099 (FAS) - (06/04)

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