496803362-3-10-2023-21-AS-HDBI-CQ8UUJ-20230324155335

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803362
Report Date: 03/10/2023
Date Signed: 03/10/2023 02:24:24 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
01/04/2023 and conducted by Evaluator Victoria Bertozzi

COMPLAINT CONTROL NUMBER: 21-AS-20230104135459

FACILITY NAME:	VALLEY VIEW CARE HOME		FACILITY NUMBER:	496803362
ADMINISTRATOR:	CREDO, JOSEPHINE		FACILITY TYPE:	740
ADDRESS:	515 MIDDLE RINCON ROAD		TELEPHONE:	(707) 538-2140
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95409
CAPACITY:	6	CENSUS:	DATE:	03/10/2023
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Licensee, Josephine Credo Alcones		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Licensee is not enforcing house rules
Resident is not an appropriate placement
Staff are not providing adequate supervision

INVESTIGATION FINDINGS:

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Licensing Program Analyst Bertozzi arrived unannounced to deliver findings regarding the above complaint allegations and met with Licensee, Josephine Credo Alcones.

Licensee is not enforcing house rules – Complaint alleges that the facility is not enforcing the house rule that states that there can be no indecent exposure despite a resident who was recently observed in another resident’s room without any clothes on. Based on interviews, the resident was observed by another resident’s family member and staff but not by other residents. Further interview revealed that complainant believes a 30-day eviction should be given. Per review of the Facility’s House Rules, “Indecent behavior or exposure is never acceptable” but does not specify the actions that will be taken if the rule is broken.

Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023

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-20230104135459

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: VALLEY VIEW CARE HOME	FACILITY NUMBER: 496803362
	VISIT DATE: 03/10/2023

NARRATIVE

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Continued from LIC9099

Per interview with Administrator, they did not issue a 30-day eviction and instead had resident re-evaluated by their doctor and increased staff supervision. Regulation indicates that if a resident does not follow general policies of the facility, they “may” be evicted.

Resident is not an appropriate placement – Complainant alleges that due to the noted resident’s behavior, they are not an appropriate placement. Per interview with Administrator, the identified resident was evaluated prior to moving in and Administrator determined they were appropriate based on their assessment. Per LPA review of the physician’s report dated 12/2022, the resident did not have any inappropriate behaviors. Additionally, inappropriate behaviors were not noted on the Pre-Placement Appraisal conducted 12/2022. Per file review, after resident moved into the facility and began to exhibit additional behaviors, the Administrator conducted a reassessment and had resident reassessed by their doctor. Following the reassessment, the Administrator determined that they were able to continue meeting the resident's needs.

Staff are not providing adequate supervision – Complainant alleges that the facility is not providing adequate supervision which resulted in a resident going into another resident’s room without any clothes on. Review of pre-placement appraisal and appraisal, resident did not require one to one supervision. Per interviews, once resident was observed in another resident’s room without clothes on, the facility increased supervision and installed a motion detector to alert staff.

A finding that the complaint allegations that Licensee is not enforcing house rules, Resident is not an appropriate placement and Staff are not providing adequate supervision were unsubstantiated meaning that although the allegations may have happened there is not a preponderance of evidence to prove that the allegations occurred.

No deficiencies cited.

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023

LIC9099 (FAS) - (06/04)

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