<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496803621
Report Date: 03/10/2022
Date Signed: 03/10/2022 09:46:45 AM



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
02/17/2022 and conducted by Evaluator Marisol Cuadra
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20220217163350
FACILITY NAME:LIGHT HOUSEFACILITY NUMBER:
496803621
ADMINISTRATOR:PATEL, DHARMISTHAFACILITY TYPE:
740
ADDRESS:101 ANISH WAYTELEPHONE:
(707) 620-0529
CITY:WINDSORSTATE: CAZIP CODE:
95492
CAPACITY:6CENSUS: 6DATE:
03/10/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Dharmi Patel (Licensee)TIME COMPLETED:
10:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is not allowing visitation
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Cuadra conducted an unannounced complaint investigation regarding the above allegation and met with Licensee, Dharmi Patel for the purpose of closing the complaint.

It was alleged that facility is not allowing visitation. Reporting party called CCL to report that resident (R1) was not being allowed visitors. LPA conducted 10-day complaint inspection on 2/25/22 and conducted confidential interviews with staff, resident and R1’s fiduciary. Based on records review and confidential interviews, responsible parties and fiduciary who handles R1’s health and financial decisions has requested facility to not allow visitors for R1 due to different matters. However, during records review, there is no legal documentation preventing any visitors to come and visit R1. Facility provided documentation along with visitor’s sign-in sheets for the month of January and February 2022 that indicates that the facility is allowing visitors for residents in care. LPA also conducted interviews with R1 who expressed their wishes to continue to receive visitors and relations with persons of their preferences.
Continues on LIC9099C...
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol CuadraTELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022
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-20220217163350
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: LIGHT HOUSE
FACILITY NUMBER: 496803621
VISIT DATE: 03/10/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Continued from LIC9099...

Based on LPA’s observations, interviews which were conducted and review of records, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8 and the Health and Safety Code), are being cited on the attached LIC 9099D.



SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol CuadraTELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 21-AS-20220217163350
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: LIGHT HOUSE
FACILITY NUMBER: 496803621
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/10/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/24/2022
Section Cited
CCR
87468.1(a)(11)
1
2
3
4
5
6
7
87468.1 Personal Rights of Residents in All Facilities (a) Residents in all RCFE shall have all of the following personal rights: (11) To have their visitors…permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon. This requirement has not been met as evidence by:
1
2
3
4
5
6
7
Licensee will ensure that residents rights are maintained and R1 will be able to receive visitors. Licensee will submit a self-certification (LIC9098) that all staff had been notified about regulation by POC due date.
8
9
10
11
12
13
14
Based on records review and interviews with Licensee and outside parties, facility was not allowing visitors to R1 which poses a potential risk to the health and safety of residents in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol CuadraTELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3