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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496804028
Report Date: 04/27/2023
Date Signed: 04/27/2023 04:44:48 PM

Unfounded


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
04/21/2023 and conducted by Evaluator Victoria Bertozzi
COMPLAINT CONTROL NUMBER: 21-AS-20230421075815
FACILITY NAME:TREEHOUSE SENIOR LIVINGFACILITY NUMBER:
496804028
ADMINISTRATOR:PATEL, DHARMISTHABENFACILITY TYPE:
740
ADDRESS:1879 ALAN DRIVETELEPHONE:
(707) 665-5624
CITY:PENNGROVESTATE: CAZIP CODE:
94951
CAPACITY:10CENSUS: 7DATE:
04/27/2023
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Administrator, Dharmisthaben (Dharmi) PatelTIME COMPLETED:
04:55 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility threatened to discharge/evict resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst Bertozzi arrived unannounced to conduct a Complaint Investigation regarding the above complaint allegation and met with Administrator, Dharmisthaben (Dharmi) Patel.

LPA conducted interviews and made observations.

Facility threatened to discharge/evict resident - Complaint alleges that facility threatened to evict a resident. Additional interview revealed that Licensee communicated that facility may need to issue a 30 day eviction due to a resident potentially needing a higher level of care and it was not meant to be a threat.

This agency has investigated the complaint alleging that facility threatened to discharge/evict resident. 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:
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Bertozzi
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023
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 2
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
04/21/2023 and conducted by Evaluator Victoria Bertozzi
COMPLAINT CONTROL NUMBER: 21-AS-20230421075815

FACILITY NAME:TREEHOUSE SENIOR LIVINGFACILITY NUMBER:
496804028
ADMINISTRATOR:PATEL, DHARMISTHABENFACILITY TYPE:
740
ADDRESS:1879 ALAN DRIVETELEPHONE:
(707) 665-5624
CITY:PENNGROVESTATE: CAZIP CODE:
94951
CAPACITY:10CENSUS: 7DATE:
04/27/2023
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Administrator, Dharmisthaben (Dharmi) PatelTIME COMPLETED:
04:55 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Physical Plant
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst Bertozzi arrived unannounced to conduct a Complaint Investigation regarding the above complaint allegation and met with Administrator, Dharmisthaben (Dharmi) Patel.

LPA conducted interviews and made observations.
Physical Plant - Complaint alleges that there are parts of the floor that are coming up creating a tripping hazard. LPA observed tape on the floor of one of seven resident's rooms. Interviews revealed that the facility has an ongoing issue with the flooring in the observed room and intend to change the flooring but can't while a resident resides in the room. Per interview with Licensee, they have nailed down the floor boards and staff continue to monitor the floor to ensure it is not a tripping hazard.

A finding that the complaint allegation of Physical Plant was unsubstantiated meaning that although the allegation may have happened there is not a preponderance of evidence to prove that the allegation occurred. No deficiencies cited.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Bertozzi
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023
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 2