486803987-7-18-2025-21-AS-KMOA-DK2RTV-20250729131859

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803987
Report Date: 07/18/2025
Date Signed: 07/18/2025 09:47:28 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 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
06/17/2025 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20250617093603

FACILITY NAME:	HEART AND HAVEN HOMECARE, THE		FACILITY NUMBER:	486803987
ADMINISTRATOR:	GUINTO, DANTE		FACILITY TYPE:	740
ADDRESS:	1442 GRANADA STREET		TELEPHONE:	(707) 651-9299
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94591
CAPACITY:	6	CENSUS: 2	DATE:	07/18/2025
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Jean Rice		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staff did not seek timely medical care

INVESTIGATION FINDINGS:

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At approximately 8:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived unannounced and met with Administrator Jean Rice to deliver findings of a complaint investigation-initiated June 17, 2025. During the course of this investigation, outside records were reviewed, observations were made, and interviews conducted. Complaint alleges staff did not seek timely medical care due to staff (S1) not contacting emergency personnel upon the death of Resident (R1). Upon S1 finding R1 unresponsive, S1 did not call emergency personnel, but contacted the Administrator who informed S1 to contact R1’s family and the mortuary be contacted. R1 was not on hospice. S1 is not qualified to pronounce a resident deceased and did not follow the proper procedure to contact 911. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation staff did not seek timely medical care is found to be SUBSTANTIATED. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Jean Rice and Appeal rights were given.
The Regional office will be conducting a Non-compliance Conference with Licensee, time and date to be determined.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2025

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 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 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
06/17/2025 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20250617093603

FACILITY NAME:	HEART AND HAVEN HOMECARE, THE		FACILITY NUMBER:	486803987
ADMINISTRATOR:	GUINTO, DANTE		FACILITY TYPE:	740
ADDRESS:	1442 GRANADA STREET		TELEPHONE:	(707) 651-9299
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94591
CAPACITY:	6	CENSUS: 2	DATE:	07/18/2025
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Jean Rice		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

1
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5
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8
9

Questionable death

INVESTIGATION FINDINGS:

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12
13

At approximately 8:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived unannounced and met with Administrator Jean Rice to deliver findings of a complaint investigation-initiated June 17, 2025. During the course of this investigation, outside records were reviewed, observations were made, and interviews conducted. The complaint alleges questionable death. Based on interviews that were conducted with facility staff and a review of R1’s medical records, it was determined that R1 was not on hospice but had been recently seen at the hospital on June 10, 2025 for a medical condition. R1 passed away on June 16, 2025. An autopsy was performed by the Solano County Coroner’s Office and the cause of death was a condition with onset for years. The death certificate does not indicate R1’s death as questionable in any manner.

Although the allegation, questionable death may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 21-AS-20250617093603

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: HEART AND HAVEN HOMECARE, THE	FACILITY NUMBER: 486803987
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/18/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/21/2025 Section Cited CCR 87465(g)	1 2 3 4 5 6 7	87465(g) Incidental Medical and Dental Care Services - The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis …	1 2 3 4 5 6 7	Licensee will ensure timely medical attention is sought for residents. Licensee agrees to submit a plan and procedure regarding residents needing medical attention due to any condition appearing life threatening and how medical attention will be provided.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based on interviews & record reviews it was determined that staff (S1) failed to seek medical attention for 1 of 1 residents found unresponsive which poses an immediate health & safety risk to residents in care.	8 9 10 11 12 13 14	Licensee will submit plan and procedure to LPA by POC date of 07/21/2025. *Facility will be scheduled a Non-compliance Conference at the Santa Rosa Regional Office.*
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Kimberley Mota
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2025

LIC9099 (FAS) - (06/04)

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