496803311-9-26-2022-21-AS-CMAZ-CNMSBX-20230201124437

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803311
Report Date: 09/26/2022
Date Signed: 09/26/2022 03:40:18 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
09/21/2022 and conducted by Evaluator Dina Alviso

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20220921100445

FACILITY NAME:	PLATINUM RESIDENTIAL CARE HOME		FACILITY NUMBER:	496803311
ADMINISTRATOR:	SISNEROS, TOSHA		FACILITY TYPE:	740
ADDRESS:	1972 DENNIS LANE		TELEPHONE:	(707) 757-8607
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95403
CAPACITY:	6	CENSUS: 6	DATE:	09/26/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Mera Shaughnessey-Licensee		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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Staff do not provide residents with a reasonable level of personal privacy
Staff are not adequately trained for the job they are assigned
Staff speaks inappropriately to residents in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst(LPA) Alviso conducted a complaint inspection, on 9/26/22 at approximately 10:20am. and met with Licensee Mera Shaughnessey, and Administrator Tosha Sisneros. There are currently six(6) residents in care.

LPA toured the facility. LPA reviewed files, including staff training's. LPA conducted interviews with six(6) staff, and other parties regarding the allegations. The investigation revealed that all staff have required training's, including resident rights, medication training, dementia care, and providing care needs/services to residents in care. There is a camera in the common area of the facility, and this camera does not have audio; Licensee stated that there are no video cameras in any other room in the facility, this includes all resident rooms and bathrooms.
Continued on LIC9099C...

Unsubstantiated

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: 09/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022

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-20220921100445

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: PLATINUM RESIDENTIAL CARE HOME	FACILITY NUMBER: 496803311
	VISIT DATE: 09/26/2022

NARRATIVE

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Per Licensee and the Administrator, progress notes on residents are documented and all staff are updated coming on shift, and by an all staff only group text; If there are any pictures with the text these would not be inappropriate pictures of the client. Per interviews with staff, the group text is for staff only and staff state that it is so everyone is on the same page regarding all residents current needs and/or concerns, and they have not observed any inappropriate items in the text. Per interviews with staff, staff deny that they are speaking to residents inappropriately. All staff have personal rights training and elder abuse training per records review.

Per LPA interviews , and record reviews, the allegations of staff do not provide residents with a reasonable level of personal privacy, staff are not adequately trained for the job they are assigned, and staff speaks inappropriately to residents in care, are unsubstantiated.

Based on the Departments investigation, interviews, file reviews, there is insufficient information to prove or disprove the allegations. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated.

No deficiencies and/or citations issued today.
Exit interview conducted with Licensee Mera Shaunessey, and Administrator Tosha Sisneros.

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Dina Alviso	TELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022

LIC9099 (FAS) - (06/04)

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