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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496801090
Report Date: 10/09/2024
Date Signed: 10/09/2024 02:59:01 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
05/31/2024 and conducted by Evaluator Dina Alviso
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20240531164055
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: DATE:
10/09/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Karrie Hanna-Resident Care CoordinatorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff mismanaged resident’s medication
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Alviso, conducted a complaint inspection, approximately 9:30am on 10/9/24, and met with Resident Care Coordinator(RCC) Karrie Hanna. Administrator David Hanna arrived to meet with the LPA.
LPA reviewed resident's (R1) records, including medical documentation, conducted interviews with staff, and other related parties. The investgation revealed that R1 has a care plan in place, and all medications prescribed by the Physician, were on-site, and inaccessible to all others that don't handle the medications. All R1's medications have Dr's Orders, per review of records. There was information and/or provided records that showed a mismanagement of R1's medications. Per interviews with staff, S1 & S2, all of R1's medications are provided as directed by the Physician, per the dosage instructions. There was conflicting information obtained regarding reported allegation of "Staff mismanaged resident’s medication". There was no information obtained that supported a violation had occurred regarding the allegation.
Based on the interviews, record reviews, including medical documentation, and Observations, there was no information obtained that supported the above violation had occurred. The allegation is Unsubstantiated, meaning that although the allegation 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 David Hanna.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Dina AlvisoTELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024
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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