496803958-8-5-2021-21-AS-BMOS-C5ZSHR-20210818135355

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803958
Report Date: 08/05/2021
Date Signed: 08/05/2021 11:00:32 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/10/2021 and conducted by Evaluator Marisol Cuadra

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20210610110811

FACILITY NAME:	REDWOOD SANTA ROSA		FACILITY NUMBER:	496803958
ADMINISTRATOR:	CARDENAS, CRISANTE		FACILITY TYPE:	740
ADDRESS:	1727 BURBANK AVE		TELEPHONE:	(707) 542-1940
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95407
CAPACITY:	26	CENSUS:	DATE:	08/05/2021
		ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Anthony Barbato (Licensee)		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Facility not providing an environment that is safe, sanitary and in good repair
Personal Rights

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cuadra arrived announced to the facility and met with Licensee, Anthony Barbato to deliver findings regarding the complaint allegations above. During the course of the investigation LPA reviewed documentation from City and County officials as well as documentation and photos taken by witnesses. LPA interviewed staff, responsible parties and the Long-Term Care Ombudsman.
In addition to the information gathered during the investigation and prior to CCL receiving the complaint, LPA was alerted by the facility on the afternoon of May 28, 2021, that they would be doing some plumbing work and the water would be shut-off for for a period of time. LPA requested the Licensee submit a written plan to ensure the needs of the residents in care would be met. The Licensee submitted a plan, which was under review by the Department. On June 8, 2021 LPA was notified that the facility was not changing the temporary waste bags in the toilet after each use as noted in their plan and photos obtained (on file) show solid waste sitting in a facility toilet bowl, unchanged after use. On June 9, 2021, LPA was notified that City Code Enforcement was going to shut down the facility due to a sewer leak under the house and the unsafe conditions for residents and staff and all residents would need to be relocated.
Continues on LIC9099C...

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol Cuadra	TELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021

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-20210610110811

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: REDWOOD SANTA ROSA	FACILITY NUMBER: 496803958
	VISIT DATE: 08/05/2021

NARRATIVE

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Continued from LIC9099…

In response to the concerns, LPA conducted a case management visit on June 9, 2021 to make observations and verify the status of the facility. Licensee was required to move all residents and staff to other locations pending the outcome of the City/County Inspectors. In review of the City’s “Order to Vacate” LPA learned that raw sewage was spilling out under the house, there were tears in the HVAC ducts under the house as well as evidence that the rodent issues previously cited for at the facility were present again.

Based on the information gathered prior to and during the investigation the complaint allegation of “Facility not providing an environment that is safe, sanitary and in good repair” is substantiated.

A health and safety check was conducted at a relocation site on June 10, 2021 at which time LPA learned that six (6) of fourteen (14) residents (R1, R2, R3, R4, R5 and R6) were required to share a bed with at least one (1) other resident. Staff were present on various floors of the relocation site the first night rather than having a staff in each resident room 24/7 to ensure resident needs were met. On June 14, 2021 Licensee notified LPA that the thirteen (13) residents residing in the hotel were again relocated to other licensed facilities in Sonoma County due to the timeframes for repairs and to ensure property care and supervision of residents.

Based on the evidence observed on-site, photos and obtained from interviews the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Health and Safety Code is being cited on the attached LIC 9099D. Appeal Rights Given.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol Cuadra	TELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021

LIC9099 (FAS) - (06/04)

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Control Number 21-AS-20210610110811

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: REDWOOD SANTA ROSA	FACILITY NUMBER: 496803958
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/05/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/05/2021 Section Cited HSC 1569.269	1 2 3 4 5 6 7	Type A – §1569.269 Enumerated rights; severability (a) Residents of RCFE shall have all of the following rights: (5) To be accorded safe, healthful, & comfortable accommodations...(6) To care... & services that meet their individual needs & are delivered by staff that are sufficient in numbers...to meet their needs. This requirement has not been met as evidence by:	1 2 3 4 5 6 7	POC: Licensee has issued a 60-day Notice of eviction to residents in care. All residents have been relocated and facility will be closed.
	8 9 10 11 12 13 14	Based on records review, observations and interviews conducted Licensee did not ensure to services were provided necessary to meet individual care needs which poses an immediate risk to the health and safety of residents in care.	8 9 10 11 12 13 14
Type A 08/05/2021 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	Type A - 87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement has not been met as evidence by:	1 2 3 4 5 6 7	POC: Licensee has issued a 60-day Notice of eviction to residents in care. All residents have been relocated and facility will be closed.
	8 9 10 11 12 13 14	Based on records review, observations and interviews conducted Licensee did not ensure facility that was clean, safe, sanitary and in good repair at all times which poses an immediate risk to the health and safety of residents in care.	8 9 10 11 12 13 14

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 Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol Cuadra	TELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021

LIC9099 (FAS) - (06/04)

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