496803880-4-4-2023-21-AS-HDBI-CQU2WK-20230412174541

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803880
Report Date: 04/04/2023
Date Signed: 04/04/2023 09:45:48 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
02/13/2023 and conducted by Evaluator Victoria Bertozzi

COMPLAINT CONTROL NUMBER: 21-AS-20230213150043

FACILITY NAME:	CANTERBURY HOME, THE		FACILITY NUMBER:	496803880
ADMINISTRATOR:	FLETCHER, SOPHIE ANNA		FACILITY TYPE:	740
ADDRESS:	2630 CANTERBURY DRIVE		TELEPHONE:	(707) 578-4309
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95405
CAPACITY:	6	CENSUS: 4	DATE:	04/04/2023
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	General Manager, Gigi Borja		TIME COMPLETED:	09:55 AM

ALLEGATION(S):

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Personal rights - Staff touch residents inappropriately
Medications - Medication is not dispensed per physicians orders

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bertozzi arrived unannounced to deliver findings regarding the above complaint allegations and and met with General Manager, Gigi Borja.

Staff touch residents inappropriately - Complaint alleges that there are female residents who do not want male staff bathing them and a female staff touched a male resident in their genital area. Per interviews, there is at least one female resident who prefers to not be assisted by a male or have a male in their room. Noted resident confirmed that facility follows this resident's preference and male staff do not assist them or come in their room. Per interviews, identified female staff is currently training and does not work with residents alone or assist with hands on care.

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: 04/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023

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 4

Control Number 21-AS-20230213150043

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: CANTERBURY HOME, THE	FACILITY NUMBER: 496803880
	VISIT DATE: 04/04/2023

NARRATIVE

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Continued from LIC9099

Medication is not dispensed per physicians orders - Complaint alleges that noted staff do not read English so are unable to give medications causing residents to not receive their medication. Per interviews, identified staff were being trained and did not assist residents with self-administration of medication.

A finding that the complaint allegations Staff touch residents inappropriately and that Medication is not dispensed per physicians orders was 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: 04/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
02/13/2023 and conducted by Evaluator Victoria Bertozzi

COMPLAINT CONTROL NUMBER: 21-AS-20230213150043

FACILITY NAME:	CANTERBURY HOME, THE		FACILITY NUMBER:	496803880
ADMINISTRATOR:	FLETCHER, SOPHIE ANNA		FACILITY TYPE:	740
ADDRESS:	2630 CANTERBURY DRIVE		TELEPHONE:	(707) 578-4309
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95405
CAPACITY:	6	CENSUS: 4	DATE:	04/04/2023
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	General Manager, Gigi Borja		TIME COMPLETED:	09:55 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Training - Staff do not have proper training on file
Personal rights - Staff cannot communicate with residents in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Bertozzi arrived unannounced to deliver findings regarding the above complaint allegations and and met with General Manager, Gigi Borja.

Staff do not have proper training on file - Complaint alleges that noted staff are not trained per regulation. Per interviews, noted staff were currently in the middle of training and were not yet working directly with residents. Review of training records showed that identified staff were being trained in accordance with regulation and training is documented.

Continuied on LIC9099C

Unfounded

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: 04/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 21-AS-20230213150043

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: CANTERBURY HOME, THE	FACILITY NUMBER: 496803880
	VISIT DATE: 04/04/2023

NARRATIVE

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Continued from LIC9099

Staff cannot communicate with residents in care - Complaint alleges that noted staff do not speak English and are unable to communicate with residents. Per interviews, identified staff were being trained and were not with residents without their trainer and did not communicate with residents directly. Per resident interviews, they are able to effectively communicate with staff.

This agency has investigated the complaint alleging that staff do not have proper training on file and Staff cannot communicate with residents in care. 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.

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4