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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803713
Report Date: 03/29/2022
Date Signed: 03/29/2022 01:28:05 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, 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
10/15/2021 and conducted by Evaluator Karina Canela
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:
03/29/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:House Manager Raquel Cistac TIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Staff working at facility without receiving training
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Canela arrived unannounced to deliver findings for complaint 21-AS-20211015090337 at Ruthie’s Home on 03/29/2022. LPA met with House Manager Raquel Cistac.

LPA investigated the above allegation of "staff working at facility without receiving training". During the investigation, LPA requested and obtained copies of facility documents, conducted interviews, and made observations. It was reported that staff are working without training.

Report continued on LIC9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Karina Canela
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022
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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: RUTHIE'S HOME
FACILITY NUMBER: 486803713
VISIT DATE: 03/29/2022
NARRATIVE
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Review of facility staff files with House Manager Raquel Cistac revealed lack of proof of current required annual staff training for staff (S1, S2, S3, S4, S5, S6) in the following subjects: (1) Principles of nutrition, food preparation and storage and menu planning, (2) Housekeeping and sanitation principles, (3) Provision of client care and supervision, including communication, (4) Assistance with prescribed medications which are self administered, (5) Recognition of early signs of illness and the need for professional assistance, and (6) Availability of community services and resources.

Additionally, 3 of 7 staff, (S1, S2, S3) do not have proof of current First Aid certification as required.


Based on observations, records reviewed, and interviews conducted, the Licensee did not ensure staff received required annual training. The preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.


Appeal Rights Provided.
Deficiencies cited (see LIC809-D page) from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiencies and/or repeat deficiencies within a 12 month period may result in civil penalties.
Exit interview conducted with House Manager Raquel Cistac whose signature below confirms receipt of report.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Karina Canela
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022
LIC9099 (FAS) - (06/04)
Page: 2 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: RUTHIE'S HOME
FACILITY NUMBER: 486803713
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/12/2022
Section Cited
CCR
80065(f)
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80065 Personnel Requirements: (f) All personnel shall be given on-the-job training or shall have related experience which provides knowledge of and skill in the following areas, as appropriate to the job assigned ...This Requirement was not met as evidenced by:
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Licensee to submit proof of staff required 36 annual training for all staff (6 of 7).
Copies of training to be submitted to Community Care Licensing attention LPA Karina Canela by POC due date 04/12/2022 to clear the citation. If more time is needed, Licensee shall request it from LPA prior to the due date.
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Based on records reviewed, 6 of 7 staff do not have proof of current required trainings. Licensee failed to ensure the regulation above. This is a potential health, safety, and personal rights risk to clients in care.
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Type B
04/12/2022
Section Cited
CCR
80075(f)
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80075 Health Related Services: (f)Staff responsible for providing direct care and supervision shall receive training in first aid from persons qualified by agencies including but not limited to the American Red Cross. This Requirement was not met as evidenced by:
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Licensee to submit proof of first aid certification for 3 of 7 staff.
Copies of first aid vertification to be submitted to Community Care Licensing attention LPA Karina Canela by POC due date 04/12/2022 to clear the citation. If more time is needed, Licensee shall request it from LPA prior to the due date.
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Based on records reviewed, 3 of 7 staff do not have proof of current First Aid certifications. Licensee failed to ensure the regulation above. This is a potential health, safety, and personal rights risk to clients in care.
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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: 03/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022
LIC9099 (FAS) - (06/04)
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