496800549-2-13-2024-21-AS-BMOS-D32P4A-20240304095849

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496800549
Report Date: 02/13/2024
Date Signed: 02/13/2024 11:24:13 AM

Unsubstantiated

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
10/11/2023 and conducted by Evaluator Dina Alviso

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20231011140658

FACILITY NAME:	ALVAREZ FAMILY HOME		FACILITY NUMBER:	496800549
ADMINISTRATOR:	CHARLENE ALVAREZ		FACILITY TYPE:	740
ADDRESS:	2185 FLORAL WAY		TELEPHONE:	(707) 545-6464
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95403
CAPACITY:	6	CENSUS: 4	DATE:	02/13/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Emma Mutunga-Administrator		TIME COMPLETED:	11:10 AM

ALLEGATION(S):

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Neglect/lack of care & supervision leading to hospitalization of the resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alviso delivered findings of the Departments complaint investigation, on 2/13/24 at approximately 9:00am, and met with Administrator Emma Mutunga.

The reporting party (RP) alleges that staff (S1) neglect/lack of care & supervision led to hospitalization of the resident. R1 was transported to the hospital for increased generalized weakness. R1 was medically assessed and found to have a cloth in their severely contracted right hand that may have been there for several days. There was concern of an infection, and a foul odor from R1’s fingers on their right hand. R1 had the tip of two right hand fingers partially amputated. The Department reviewed records and conducted interviews regarding the allegation of “neglect/lack of care & supervision, leading to hospitalization of the resident.

The investigation revealed R1 has a diagnosis of severely contracted hands. R1 has a history of reoccurring urinary tract infections. A medical professional (MP1) was interviewed with knowledge of R1’s medical history, including their contractures.
Continued on LIC9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Dina Alviso	TELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024

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-20231011140658

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: ALVAREZ FAMILY HOME	FACILITY NUMBER: 496800549
	VISIT DATE: 02/13/2024

NARRATIVE

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To relieve tension, they (medical professional) directed staff to roll towels up, and place them in R1’s hands, to prevent fingers from digging into R1’s palms. The medical professional sees R1 regularly, and staff have contacted them regarding R1's medical care needs. Medical information obtained document that R1 has significant contractures to both hands, so severe, that a medical professional (MP2) couldn't open them to fully assess R1's hand(s). Per interviews with staff (S1), staff did not observe signs of an infection to R1’s contracted hands/fingers; Staff stated R1’s towels for their contracted hands were changed daily. Interview conducted on 12/27/23 with placement agency service coordinator provided no information revealing concern of R1s care residing at current placement. There was no information obtained during the investigation to support a violation had occurred regarding the allegation.

Based on the interviews, record/document reviews, and related information obtained during the investigation, the allegation of “neglect/lack of care & supervision leading to hospitalization of the resident” is Unsubstantiated, meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

No deficiencies cited.
Exit interview was conducted with the Administrator Emma Mutunga.

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Dina Alviso	TELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024

LIC9099 (FAS) - (06/04)

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