496803920-4-4-2023-21-AS-HDBI-CQU349-20230412175446

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803920
Report Date: 04/04/2023
Date Signed: 04/04/2023 11:25:00 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-20230213145401

FACILITY NAME:	ORCHARD INN		FACILITY NUMBER:	496803920
ADMINISTRATOR:	FLETCHER, SOPHIE ANNA		FACILITY TYPE:	740
ADDRESS:	2228 SYCAMORE AVE		TELEPHONE:	(972) 983-3008
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95404
CAPACITY:	6	CENSUS: 4	DATE:	04/04/2023
		UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Staff Lorna Sison		TIME COMPLETED:	11:35 AM

ALLEGATION(S):

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Medications - Medication is not dispensed per physicians orders
Personal rights - Staff cannot communicate with residents in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bertozzi arrived unannounced to deliver findings regarding the above complaint allegations and and met staff Lorna Sison. General Manager, Gigi Borja was available by phone and gave permssion for staff to sign report.

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.

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)

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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-20230213145401

FACILITY NAME:	ORCHARD INN		FACILITY NUMBER:	496803920
ADMINISTRATOR:	FLETCHER, SOPHIE ANNA		FACILITY TYPE:	740
ADDRESS:	2228 SYCAMORE AVE		TELEPHONE:	(972) 983-3008
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95404
CAPACITY:	6	CENSUS: 4	DATE:	04/04/2023
		UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Staff Lorna Sison		TIME COMPLETED:	11:35 AM

ALLEGATION(S):

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9

Training - Staff do not have proper training on file

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bertozzi arrived unannounced to deliver findings regarding the above complaint allegation and and met staff Lorna Sison. General Manager, Gigi Borja was available by phone and gave permssion for staff to sign report.

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.

This agency has investigated the complaint alleging that staff do not have proper training on file. 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.

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: 2 of 3

Control Number 21-AS-20230213145401

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: ORCHARD INN	FACILITY NUMBER: 496803920
	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. Interviewed residents reported occasional to no issues with communication with staff. Per interview, in the case of there being a momentary language barrier, another staff has been available that resident was able to communicate with.

A finding that the complaint allegations that Medication is not dispensed per physicians orders and Staff cannot communicate with residents in care 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 during inspection.

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)

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