496801090-8-24-2023-21-AS-KMOA-CW5TKD-20230929144747

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496801090
Report Date: 08/24/2023
Date Signed: 08/24/2023 05:26:08 PM

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
06/12/2023 and conducted by Evaluator Dina Alviso

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20230612151510

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:	DATE:	08/24/2023
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	David Garcia-Administartor		TIME COMPLETED:	05:25 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not provide residents with modified diets as prescribed
Staff do not ensure facility plumbing is functioning properly, toilet(s) are not flushing
Staff do not safeguard resident's personal belongings
Staff yell at residents in care
Staff do not ensure the facility is free from bed bugs

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Alviso, conducted a subsequent complaint visit, approximately 2:00pm on 8/24/23,, and met with Administrator David Hanna, and Resident Care Coordinator(RCC) Karrie Hanna.

LPA reviewed four resident files. LPA reviewed four staff files. The LPA conducted interviews with fiver(5) staff, and other interested/related parties, regarding the allegations. The investigation revealed that the facility has a resident(R2) that is on a low sugar special diet. Per LPA interviews,facility is aware of residents low sugar diet, and resident is redirected when needed to healthier food choices; Resident does choose for themselves and it is their personal right but RCC stated they will document it for the record.. RCC stated if needed the information is able to be provided to the Physician. Facility stated they like to prepare food at a low sodium use for all residents. LPA observed regular and almond milk, gluten free mixes for desserts, and a supply of seasonings, other than salt, for preparing meals. The facility had a large supply of perishable and non-perishable food. Per the investigation, there was no information obtained to support that a violation had occurred.
Continued on LIC9099C...

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Dina Alviso	TELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

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-20230612151510

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: 08/24/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA observed the facility toilets to all be working properly during the inspection. The investigation revealed that the Administrator has several facility bathrooms that may be used by residents if a toilet clogs up and/or has plumbing issues. All showers are working properly, including sinks. The facility has staff that handle maintenance, and if a toilet couldn't be unclogged or there were plumbing issues a plumbing service would be contacted. Per the investigation, there was no information obtained to support that a violation had occurred.

All resident rooms have locks on the outside of their doors but from the inside the door can be opened at any time by the residing resident. When the resident bedroom door is closed, it automatically locks, which keeps residents belongings safe and secure in their own room. Residents that understand their door lock can get back in, and other residents are able to be let in by staff as needed. If residents ask that they have food/drink items to store in the kitchen refrigerator they are able to, per interviews with staff. The residents name is written on the item(s) and put into the refrigerator in the locked kitchen area. The kitchen doors are kept locked and only accessed by staff. A resident will ask the staff for their food/drink items when they want them, and staff will provide these items to the resident. Per the investigation, there was no information obtained to support that a violation had occurred.

LPA conducted interviews with staff and other related parties. Information obtained didn't support that a violation had occurred regarding staff yelling at residents and/or speaking to residents inappropriately. All staff have criminal record clearance as required. Staff have required training.

Per investigation, interviews, and observations, the facility does not have an outbreak of bed bugs. The facility has not had a case of bed bugs now and/or prior to the investigation. The facility has had scabies, and all residents were treated as needed and required, per review of records. Per the investigation, there was no information obtained to support that a violation had occurred.

Based on the interviews, record/document reviews, and related information obtained during the investigation, of the allegations "Staff do not provide residents with modified diets as prescribed, Staff do not ensure facility plumbing is functioning properly, toilet(s) are not flushing, Staff do not safeguard resident's personal belongings, Staff yell at residents in care, Staff do not ensure the facility is free from bed bugs" are Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

No deficiencies cited.
Exit interview was conducted with the Administrator David Hanna.

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Dina Alviso	TELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2