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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496801929
Report Date: 06/17/2025
Date Signed: 06/17/2025 02:38:47 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
04/28/2025 and conducted by Evaluator Christi Coppo
COMPLAINT CONTROL NUMBER: 21-AS-20250428125354
FACILITY NAME:FRIENDS HOUSEFACILITY NUMBER:
496801929
ADMINISTRATOR:ROBERT RUBIOFACILITY TYPE:
741
ADDRESS:684 BENICIA DRIVETELEPHONE:
(707) 538-0152
CITY:SANTA ROSASTATE: CAZIP CODE:
95409
CAPACITY:145CENSUS: 12DATE:
06/17/2025
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Robert Rubio, AdministratorTIME COMPLETED:
02:53 PM
ALLEGATION(S):
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Facility is not ensuring resident’s incontinence needs are me
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christi Coppo arrived at this facility deliver complaint findings on the above allegations. LPA met with Administrator Robert Rubio.

Complaint alleges facility is not ensuring resident’s incontinence needs are met. During investigation, LPA conducted interviews with staff and asked if facility has a written incontinence procedure. Facility unable to provide LPA with their written incontinence care protocols. Five [5] out of five [5] staff interviewed indicated that there is nothing in writing but that they get trained to check every 2 hours, by asking the residents verbally if they need to be changed. If a resident refuses, then they keep on asking, sometimes switching up the specific staff that asks, until the resident agrees. One staff indicated facility wants the residents to use their pendant to request incontinent care. Five [5] out of five [5] indicated they do get training from Relias but not specifically on incontinence care. All staff indicated they do get training on grooming and behaviors, some of

Continued on 9099C...
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Victoria BertozziTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Christi CoppoTELEPHONE: (707) 588-5054
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
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 3
Control Number 21-AS-20250428125354
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: FRIENDS HOUSE
FACILITY NUMBER: 496801929
VISIT DATE: 06/17/2025
NARRATIVE
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Continued from 9099...

which include incontinence care, but nothing just on incontinence care alone. During investigation, LPA interviewed residents. One [1] resident available for interview did not require incontinence care and one [1] resident available for interview did not have continuity of cognitive function or capacity to answer LPA’s questions. Three [3] out of five [5] residents indicated they use their pendants to alert staff as to when they need incontinence care. Residents indicate that the only time staff show up outside of them pressing their pendant is when they are giving them their medications. Three [3] out of five [5] residents indicated they typically have to wait between 5-15 minutes after pressing their pendant to get incontinence care, with one reporting that the longest they waited was about 30 minutes. Facility has current residents that have declining cognitive functioning such that they cannot properly communicate their needs or have ability to remember to press their pendant should they have a care need. The pendant response wait time paired with the facility’s lack of written procedure for incontinent care meets the preponderance of evidence. Therefore, based on LPA’s interviews the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 Chapter 8, are being cited on the attached 9099D.
SUPERVISOR'S NAME: Victoria BertozziTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Christi CoppoTELEPHONE: (707) 588-5054
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 21-AS-20250428125354
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: FRIENDS HOUSE
FACILITY NUMBER: 496801929
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/08/2025
Section Cited
CCR
87611(e)
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87611 General Requirements for Allowable Health Conditions (e) In addition to Sections 87465(a) and 87464(d) the licensee shall ensure that the resident is cared for in accordance with the physician's orders and that the resident's medical needs are met. This requirement not met by licensee as
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Facility to formulate and implement an incontinence protocol procedure and add it to facility's plan of operation. Facility to then conduct in-service training on newly established incontinence care protocols with direct care staff. In-service training to be conducted no later than 7/22/25
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evidenced by: Based on LPA interview and record review, the licensee did not comply with the section cited above in that facility does not have an incontinence care program/procedure that addresses and/or ensures that the facility meets the needs of those residents that lack the cognitive capacity to communicate their incontinence needs, which poses a potential health, safety or personal rights risk to persons in care.
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and submit to CCL training sign-in sheet
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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: Victoria BertozziTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Christi CoppoTELEPHONE: (707) 588-5054
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3