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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496801090
Report Date: 11/05/2024
Date Signed: 11/05/2024 02:46:05 PM

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
11/04/2024 and conducted by Evaluator Dina Alviso
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20241104104137
FACILITY NAME:HANNA HOUSE RIDLEYFACILITY NUMBER:
496801090
ADMINISTRATOR:HANNA, DAVIDFACILITY TYPE:
740
ADDRESS:1840 RIDLEY AVENUETELEPHONE:
(707) 591-0980
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY:28CENSUS: 25DATE:
11/05/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Karrie Hanna-Resident Care CoordinatorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility is not providing hygiene items/paper towels for residents use
Violation of residents personal rights
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alviso, conducted a complaint inspection, approximately 10:00am on 11/5/24, and met with Resident Care Coordinator(RCC) Karrie Hanna. RCC contacted the Administrator, David Hanna, who arrived after LPA's tour of the facility.

LPA toured the facility with RCC Karrie Hanna; The facility does have a sufficient supply of hygiene products for all residents in care, including sufficient supply of paper towels, toilet paper, and linens. LPA discussed with RCC regarding linens and that regulation states, "The use of common wash cloths and towels shall be prohibited." RCC stated their understanding of this to the LPA. RCC stated the bathrooms have paper towel dispensers.The LPA observed that there are eight (8) bathrooms in the facility for residents in care.There are four (4) bathrooms that can be used by all residents in care, and the other four (4) are jack and jill bathrooms for the specific residents who reside in the connected rooms. LPA observed that the paper towels were not available in seven out of eight resident bathrooms. Bathrooms had toilet paper available.There is soap and sanitizer dispensers available for resident use. LPA discussed with the RCC Karrie, and Administrator David, that the paper towels for residents use must be available in every resident bathroom at all times.
Continued on LIC9099C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024
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
Control Number 21-AS-20241104104137
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: HANNA HOUSE RIDLEY
FACILITY NUMBER: 496801090
VISIT DATE: 11/05/2024
NARRATIVE
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RCC had the staff filling the paper towel dispensers. Administrator stated that the dispensers that were not operational would be repaired and/or replaced. Administrator stated that all bathrooms would have a supply of paper towels for residents use at all times.
Per LPA's observations and interviews with staff, there is sufficient information obtained to support a violation did occur, the allegation of "facility is not providing hygiene items/paper towels for residents use" is Substantiated. This deficiency will be cited, 87307(a)(3) Personal Accommodations and Services- The following provisions shall apply: Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident, the licensee shall assure provision of: Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths. The use of common wash cloths and towels shall be prohibited, see LIC9099D.

LPA observed R1 in the facility, reviewed R1's records, and obtained information from interviewed staff and other related parties. Per investigation, R1 has a seat belt attached to their wheelchair that is used to keep resident in their chair; LPA observed that the seat belt goes straight across as a regular seat belt, which is not providing any postural support for the resident. Per interview with S2, the seat belt helps R1 from standing up and down when agitated, and from possible falls when leaning forward; S2 stated it keeps the resident in their chair. R1 is not able to unbuckle the seat belt on their own. LPA discussed personal rights of the resident/residents per regulation, and ensuring sufficient staff as needed. Administrator and S2 stated their understanding of the regulation. A clip alarm or similar item will be used and R1's care plan will be updated, per Administrator.
Per LPA's observations and interviews with staff, there is sufficient information obtained to support a violation did occur, the allegation of "violation of resident's personal rights" is Substantiated. This deficiency will be cited, 87468.2(a)(4)Additional Personal Rights of Residents in Privately Operated Facilities-In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs, see LIC9099D.

The preponderance of evidence standard has been met, therefore the allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is being cited.
Failure to correct deficiencies by due dates, may result in additional deficiency citations and/or civil penalties being assessed.
Exit interview conducted with the Resident Care Coordinator, Karrie Hanna.
Appeal Rights provided.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 21-AS-20241104104137
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: HANNA HOUSE RIDLEY
FACILITY NUMBER: 496801090
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/06/2024
Section Cited
CCR
87468.2(a)(4)
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87468.2(a)(4)Additional Personal Rights of Residents in Privately Operated Facilities-In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.This requirement was not met as evidenced by:
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Licensee/Administrator to ensure the seat belt is removed from R1's wheelchair; Reassess the resident, and update the care plan as needed to meet resident's current care needs. Submit proof of correction, by photo for seat belt removal, and a plan to reassess the resident,
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Per investigation, R1 has a seat belt attached to their wheelchair that is used to keep resident in their chair; LPA observed that the seat belt goes straight across as a regular seat belt, which is not providing any postural support for the resident. Per interview with S2, the seat belt helps R1 from standing up and down when agitated, and from possible falls when leaning forward; S2 stated it keeps the resident in their chair. R1 is not able to unbuckle the seat belt on their own. This is a risk to resident's personal rights and to health & safety of resident.
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 and update care plan in a timely manner, no later than 11/13 . POC due 11/06/24.
Type B
11/18/2024
Section Cited
CCR
87307(a)(3)
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87307(a)(3) Personal Accommodations and Services- The following provisions shall apply:. Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident, the licensee shall assure provision of: Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths. The use of common wash cloths and towels shall be prohibited.
This requirement was not met as evidenced by:
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Licensee/Administrator to ensure that all bathrooms have paper towels available at all times, ensuring that all paper towel dispensers work. Ensure all bathrooms have a sufficient supply of hygiene items as needed for resident use,
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Per Investigation, LPA observed that there are eight (8) bathrooms in the facility for residents in care. There are four (4) bathrooms that can be used by all residents in care, and the other four (4) are jack and jilll bathrooms for the specific residents who reside in the connected rooms. LPA observed that the paper towels were not available in seven out of eight resident bathrooms. This is a risk to residents personal rights and to the health & safety of residents in care.
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and that staff assist residents using bathrooms as needed. POC due 11/18/24.
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: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3