496802052-3-29-2024-21-AS-BMOS-D3YMZH-20240403100306

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496802052
Report Date: 03/29/2024
Date Signed: 03/29/2024 11:57:52 AM

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
11/20/2023 and conducted by Evaluator Christi Coppo

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20231120142521

FACILITY NAME:	BETSY'S II RCFE		FACILITY NUMBER:	496802052
ADMINISTRATOR:	ALICDAN, LUNINGNING		FACILITY TYPE:	740
ADDRESS:	3101 BRUSH CREEK ROAD		TELEPHONE:	(707) 537-0399
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95404
CAPACITY:	13	CENSUS:	DATE:	03/29/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Luningning Alicdan, Licensee		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Neglect/lack of supervision resulting in stage 4 pressure injury
Staff did not follow doctor’s orders for resident in care
Staff did not follow resident’s hospice care plan
Staff did not provide proper medication assistance to resident in care
Staff did not ensure resident’s incontinence needs were met in a timely manner
Staff did not treat resident with respect

INVESTIGATION FINDINGS:

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LPA Coppo met with Licensee/Administrator, Luningning "Bot" Alicdan in the Santa Rosa Regional Office to deliver findings regarding the above complaint allegations.

Neglect/lack of supervision resulting in stage 4 pressure injury – Complaint alleges that facility staff was not moving resident into more comfortable positions to relieve level 3 to 4 pressure injuries and that wound care was not being done. Pressure injury was documented on resident’s hospice care plan and per plan, resident was provided wound care by the hospice agency. Evidence indicating that staff were failing to reposition resident was unavailable.

Staff did not follow doctor’s orders for resident in care – Complaint alleges that a doctor's order had been put in place for resident to get up to use the bathroom. Per complaint, Licensee refused to follow the order and told resident to go to the bathroom in their incontinence brief.

Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Christi Coppo	TELEPHONE: (707) 588-5054
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2024

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-20231120142521

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: BETSY'S II RCFE	FACILITY NUMBER: 496802052
	VISIT DATE: 03/29/2024

NARRATIVE

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Doctor’s order was not provided. Hospice care plan indicated resident was “bedbound” and used incontinence briefs. Evidence indicating that staff failed to toilet resident per a doctor’s order could not be confirmed.

Staff did not follow resident’s hospice care plan – Complaint alleges that staff continued to provide food and water to resident in conflict with the hospice care plan. Per complaint, hospice was concerned that resident would aspirate. Review of hospice care showed that hospice instructed the use of straws to be discontinued the day prior to resident passing but document review and interviews did not indicate that hospice instructed facility staff to not provide food and water.

Staff did not provide proper medication assistance to resident in care - Complaint alleges that staff were not providing resident medications as prescribed by the doctor due to staff’s belief that the medication would cause death. Additionally, Complaint alleges that resident was not given a specific medication for many months due to staff not filling the prescription. Evidence to support this allegation was not provided. Hospice care notes indicated that resident’s family expressed concern that resident was not being given pain medication, but it was not mentioned in the notes whether hospice confirmed this.

Staff did not ensure resident’s incontinence needs were met in a timely manner– Complaint alleges that resident was left in their own stool for many hours stating that during an incontinence brief change, resident had a bowel movement that staff did not want to address so staff closed the incontinence brief, leaving the resident in their own stool. Per interview, resident was observed with two briefs on, both saturated with feces that had been liquid and then dried, indicating resident was left for multiple hours. Unable to confirm this information.

Staff did not treat resident with respect – Complaint alleges that Licensee yelled at resident and was disrespectful. Additionally, complaint alleges that after refusing to follow doctor’s orders, Licensee told resident that if they didn’t like it at the facility, they should leave. Interviews conducted where one individual described staff yelling but not at a person while others indicated that staff do not yell.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

No deficiencies cited.

SUPERVISOR'S NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Christi Coppo	TELEPHONE: (707) 588-5054
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

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
11/20/2023 and conducted by Evaluator Christi Coppo

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20231120142521

FACILITY NAME:	BETSY'S II RCFE		FACILITY NUMBER:	496802052
ADMINISTRATOR:	ALICDAN, LUNINGNING		FACILITY TYPE:	740
ADDRESS:	3101 BRUSH CREEK ROAD		TELEPHONE:	(707) 537-0399
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95404
CAPACITY:	13	CENSUS:	DATE:	03/29/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Luningning Alicdan, Licensee		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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9

Staff did not allow resident’s hospice care team into the facility

INVESTIGATION FINDINGS:

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LPA Coppo met with Administrator, Luningning "Bot" Alicdan in the Santa Rosa Regional Office to deliver findings regarding the above complaint allegations.

Staff did not allow resident’s hospice care team into the facility – Complaint alleges that the Licensee refused to allow hospice personnel in the facility. Review of hospice notes and interviews with hospice did not indicate any time where hospice was denied access to the facility.

This agency has investigated the complaint alleging Staff did not allow resident’s hospice care team into the facility. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis

No deficiencies cited.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Christi Coppo	TELEPHONE: (707) 588-5054
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2024

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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