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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496803657
Report Date: 03/07/2024
Date Signed: 03/07/2024 11:35:18 AM

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
02/01/2024 and conducted by Evaluator Marisol Cuadra
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20240201160245
FACILITY NAME:HOPE HOUSEFACILITY NUMBER:
496803657
ADMINISTRATOR:MOORE, SHANICEFACILITY TYPE:
735
ADDRESS:1550 N DUTTONTELEPHONE:
(707) 293-3138
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY:12CENSUS: 12DATE:
03/07/2024
UNANNOUNCEDTIME BEGAN:
10:03 AM
MET WITH:Rita Larson (Social Rehab Director)TIME COMPLETED:
11:50 AM
ALLEGATION(S):
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-Facility staff not allowing resident to return to the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a complaint investigation and deliver findings regarding the above allegations and met with Rita Larson (Social Rehab Director).

The Department received an allegation of facility staff not allowing a resident to return to the facility. Per Reporting Party, there is a client (C1) who will be discharged from the hospital with oxygen due to a new diagnosis of COPD, but the facility Administrator was refusing to take C1 back to the facility on oxygen even when C1 is able to independently manage their oxygen and would not need additional support from facility staff. Based on records review, LPA obtained hospital records that indicate C1 was admitted to the hospital on 1/29/24 due to complaints of shortness of breath worsening over the past few days and disposition to wear oxygen targeting to increase oxygen levels to 88-92% saturation at home. The facility provided discharge documents dated 2/2/24 indicating that C1 was admitted to the hospital for COPD exacerbation, they were treated with antibiotics and steroids.
Continues on LIC9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
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 2
Control Number 21-AS-20240201160245
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: HOPE HOUSE
FACILITY NUMBER: 496803657
VISIT DATE: 03/07/2024
NARRATIVE
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Continued from LIC9099...

On 2/2/24 C1 was sent home with medication adjustments along with a follow up appointment on 2/9/24. However, LPA reviewed incident report logs for this facility, and it was determined that incident reports were not submitted to CCL. The administrator could not provide proof that hospitalization was reported to CCL. LPA will address reporting requirements on a case management inspection. During LPA’s visit to the facility on 2/6/24; LPA made observations and conducted interviews with staff and client (C1) in care. Per C1, the issue was that their oxygen levels at the hospital were low, so their Physician ordered to wear oxygen tank at home until oxygen levels increases, but C1 ensured LPA that they are doing fine and did not have any concerns about needing to use oxygen. Per Administrator, C1 won't need to use oxygen, because their oxygen levels increased, but Administrator expressed that it could be a potential issue in a future time, so they will consider their options including relocation. LPA has provided regulations pertinent to clients using oxygen and the Administrator expressed understanding of client residing in the facility. A finding that the complaint allegation of facility staff not allowing a resident to return to the facility is unsubstantiated meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2