496801090-7-24-2023-21-AS-BMOS-CW8TCE-20231002143634

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496801090
Report Date: 07/24/2023
Date Signed: 07/24/2023 03:58:15 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
07/20/2023 and conducted by Evaluator Dina Alviso

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20230720173544

FACILITY NAME:	HANNA HOUSE RIDLEY		FACILITY NUMBER:	496801090
ADMINISTRATOR:	HANNA, DAVID		FACILITY TYPE:	740
ADDRESS:	1840 RIDLEY AVENUE		TELEPHONE:	(707) 591-0980
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95403
CAPACITY:	28	CENSUS: 27	DATE:	07/24/2023
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	David Hanna-Administrator		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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There is a strong urine odor in the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alviso, conducted a complaint inspection, approximately 2:00pm on 7/24/23 , and met with Resident Care Coordinator(RCC) Karrie Hanna. RCC contacted the Administrator, David Hanna, who arrived shortly after the LPA.

LPA toured the facility with RCC Karrie Hanna; The LPA observed a very strong urine odor when entering the facility and walking in towards the living room. The LPA walked through the living room area and observed the urine odor was very strong throughout the area. The LPA discussed the facility'sstrong urine odor, and discussed regulations regarding ensuring a facility be clean, sanitary, and in good repair, including ensuring meeting needs of incontinent residents.
Continued on LIC9099...

Substantiated

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: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

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-20230720173544

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: HANNA HOUSE RIDLEY	FACILITY NUMBER: 496801090
	VISIT DATE: 07/24/2023

NARRATIVE

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LPA observed residents sitting in the living room watching television when touring the room. LPA observed a large blanket/towel on the floor in front of the couch where a resident was sitting. The facility does provide care to incontinent residents. The RCC stated the area had been cleaned up. RCC stated that the Administrator may be removing the rug. The LPA stepped outside of the facility to continue to speak with the RCC regarding the urine odor in the facility. The Administrator arrived and the LPA discussed the complaint allegation, and LPA's observations of the strong urine odor in the facility.

The LPA toured the facility, conducted interviews with staff, and other parties. The investigation revealed that the facility does have a urine odor as you enter, and the living room has a very strong urine odor throughout. This deficiency will be cited, 87303(a)
The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors, see LIC9099D.

The conducted interviews, information obtained, and LPA's observations, supported that a violation had occurred, the allegation "there is a strong urine odor in the facility" is substantiated.

The preponderance of evidence standard has been met, therefore the allegation is 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 Administrator David Hanna.
Appeal Rights Given.

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Dina Alviso	TELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

LIC9099 (FAS) - (06/04)

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Control Number 21-AS-20230720173544

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: HANNA HOUSE RIDLEY	FACILITY NUMBER: 496801090
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/24/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/07/2023 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee/Administrator to ensure the facility is free from urine odors. Submit a plan of correction to bring the facility into compliance with the regulation, including using urine odor
	8 9 10 11 12 13 14	The LPA observed a very strong urine odor when entering the facility and walking in towards the living room. The Living room had a very strong urine odor. This a risk to personal rights of the residents in care.	8 9 10 11 12 13 14	cleaning and urine odor control products. Submit a maintenance plan on keeping the facility free of urine odors. POC due 8/7/23.
	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.

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Dina Alviso	TELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

LIC9099 (FAS) - (06/04)

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