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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496801090
Report Date: 01/09/2025
Date Signed: 01/09/2025 01:34:33 PM

Unsubstantiated


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
10/29/2024 and conducted by Evaluator Dina Alviso
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20241029100037
FACILITY NAME:HANNA HOUSE RIDLEYFACILITY NUMBER:
496801090
ADMINISTRATOR:HANNA, DAVIDFACILITY TYPE:
740
ADDRESS:1840 RIDLEY AVENUETELEPHONE:
(707) 591-0980
CITY:SANTA ROSASTATE: ZIP CODE:
95403
CAPACITY:28CENSUS: 25DATE:
01/09/2025
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Karrie Hanna-Resident Care CoordinatorTIME COMPLETED:
01:35 PM
ALLEGATION(S):
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Licensee/facility staff failed to meet resident's care need
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alviso, conducted a complaint inspection, approximately 11:20am on 1/9/25, and met with Resident Care Coordinator(RCC) Karrie Hanna. Administrator David Hanna arrived to the facility within 30 minutes after the LPA's arrival.

The LPA reviewed resident records, medical documentation, and interviewed staff, and other related parties. Reporting party alleges that "Licensee/facility staff failed to meet resident's care needs".

The investigation revealed that there are hydration times the facility provides hydration drinks, water/flavored water/tea/coffee, and other hydration fluids to residents in care; Per interviews with staff, S1, S2, S3, and S4, there are in-between mealtimes that staff offer drinks to the residents in care, as well as when the resident requests a drink and/or duriing resident mealtimes.

Staff, S2, stated that the residents are encouraged to drink their water because a lot of the residents don't drink water/drink fluids on their own. Staff are to remind residents to drink their water and to offer drinks to the resident to help ensure hydration of the residents in care. Staff deny that they refuse to provide water to residents, and are rushing residents during mealtimes so residents that are taking longer can't eat.

Per LPA's interviews with other related parties, 1, 2, and 3, in summary, they have not observed that staff don't provide water to the residents, and have observed staff giving water, tea, and coffee to residents; No staff observed rushing residents so they don't have the time to eat their food.
Continued on LIC9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025
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 2
Control Number 21-AS-20241029100037
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: 01/09/2025
NARRATIVE
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The Department didn't receive a suspected abuse report filed by a medical professional, Physician/hospital treating R1 that reports and states suspected neglect of the resident by facility staff/licensee that caused resident's dehydration.

Per investigation and review of records, including medical records, there was no information obtained to support that violations had occurred regarding the allegation reported.

Based on the interviews, record/document reviews, and related information obtained during the investigation, the allegation "Licensee/facility staff failed to meet resident's care needs” is Unsubstantiated, meaning that although the allegations may have happened or are 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 David Hanna.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2