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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803713
Report Date: 10/22/2021
Date Signed: 10/22/2021 03:36:11 PM

Substantiated


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
10/15/2021 and conducted by Evaluator Karina Canela
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20211015090337
FACILITY NAME:RUTHIE'S HOMEFACILITY NUMBER:
486803713
ADMINISTRATOR:ROBIN BRANDONFACILITY TYPE:
735
ADDRESS:3789 CLAY BANK RDTELEPHONE:
(707) 673-2047
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:4CENSUS: 2DATE:
10/22/2021
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Raquel Cistac, House ManagerTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Uncleared staff working at facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Karina Canela arrived at Ruthie's Home on 10/22/2021 for the purpose of opening a complaint investigation. LPA met with Raquel Cistac, House Manager. LPA toured the facility, reviewed facility records, conducted interviews, and obtained copies of documents.

A review of facility records and interviews conducted revealed individual (I1) was working at Ruthie's Home since 10/13/21 (photos taken). I1's fingerprint clearance is currently being processed and Licensee stated it has been in process for a long time. LPA verified through the facility Guardian Personal Report/Roster and with Community Care Licensing Rohnert Park Regional Office that I1 is currently not fingerprint cleared to work, volunteer, or be present at Ruthie's Home facility as required.

Report continued on LIC9099-C

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Karina Canela
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021
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 4
Control Number 21-AS-20211015090337
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: RUTHIE'S HOME
FACILITY NUMBER: 486803713
VISIT DATE: 10/22/2021
NARRATIVE
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LPA explained prior to anyone working (including shadowing a staff and/or training), volunteering, residing or being present in any part of the licensed facility, they are required to be fingerprint cleared and associated to the facility. LPA explained Community Care Licensing's (CCL) requirements and provided the regulation.

Licensee and House Manager stated they understood CCL's requirements and prior to anyone working, providing care, volunteering, or residing at Ruthie's Home, the individual must obtain a fingerprint clearance and be associated to the facility.

LPA previously contacted Licensee on 12/17/2020 informing the facility of a Case Closure letter for I1, which stated I1 could not work, volunteer or be present at the facility since they did not obtain an exemption to be cleared to work at Ruthie's Home.

A Civil penalty in the total amount of $500.00 was assessed today for individual (I1), who was not fingerprint cleared to this facility as required.

Appeal Rights Provided.
Deficiencies 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 with Raquel Cistac, House Manager, who's signature below confirms receipt of report.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Karina Canela
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 21-AS-20211015090337
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: RUTHIE'S HOME
FACILITY NUMBER: 486803713
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/22/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/23/2021
Section Cited
CCR
80019(e)(1)
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80019 Criminal Record Clearance - (e) All individuals subject to a criminal record review...shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as evidenced by:
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House Manager agreed to I1 cannot work or be present at the facility until they are fingerprint cleared and associated to Ruthie's Home.
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Based on record review,, and interviews conducted: Licensee did not obtain a criminal record clearance for individual (I1) prior to working at the facility.
This is an immediate safety risk to the residents in care.
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Licensee to submit a written statement they understand the requirement and will be in future compliance with the regulation by POC due date 10/25/2021 to Community Care Licensing
**Civil Penalty assessed in the amount of $500.00
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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: Hope DeBenedetti
LICENSING EVALUATOR NAME: Karina Canela
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4