525002162-12-7-2022-25-AS-MSEY-C5AUM7-20210726154151

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 525002162
Report Date: 07/22/2021
Date Signed: 12/07/2022 02:20:37 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/11/2021 and conducted by Evaluator Kevin Mknelly

COMPLAINT CONTROL NUMBER: 25-AS-20210311144929

FACILITY NAME:	HOLLIDAY HOMES LARKSPUR		FACILITY NUMBER:	525002162
ADMINISTRATOR:	HOLLIDAY, KATHERINE		FACILITY TYPE:	735
ADDRESS:	1215 LARKSPUR		TELEPHONE:	(530) 527-1883
CITY:	RED BLUFF	STATE: CA	ZIP CODE:	96080
CAPACITY:	4	CENSUS: 3	DATE:	07/22/2021
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Kathy Holliday		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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**Amended**
Facility staff are not dispensing medications as prescribed.
Facility staff are not answering the resident's authorized representatives’ communications.

INVESTIGATION FINDINGS:

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On 7/22/21 at 10:30 AM, Licensing Program Analyst (LPA) Kevin Mknelly conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met with Licensee/ Administrator, Kathy Holiday. Prior to initiating the complaint visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA did not receive call back for screening call. LPA completed a facility risk assessment prior to entering the facility. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask . Additionally, LPA was screened by Administrator.

The Department conducted records review and extensive interviews.
The Department is unable to find and or meet the preponderance, per policy.

It is documented in R1’s Individual Program Plan (IPP), dated 01/22/2021, as well as multiple other sources, that R1 has a history of disruptive behaviors, including selfinjurious behavior, assaultive behavior and not telling the truth.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021

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 25-AS-20210311144929

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: HOLLIDAY HOMES LARKSPUR	FACILITY NUMBER: 525002162
	VISIT DATE: 07/22/2021

NARRATIVE

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It was initially reported that R1 disclosed that they were drug by their feet by staff, S1, resulting in rug burns on R1’s arms; that S1 pushed R1 into a dresser, causing a large bruise to their back/hip area; and that S1 pinched their breasts.
However, when interviewed, R1 stated S1 drug R1 by the hands and on a different occasion, S1 drug R1 by their feet. R1 first stated they lost their balance and fell into the dresser when R1 was alone in their room. Later in the interview R1 said S2 had pushed R1 into the dresser. When interviewed on
03/12/2021, R1 did not disclose any sexual abuse or inappropriate touching. When reinterviewed on 06/01/2021, R1 stated that S1 grabbed R1’s breasts when they were in the hallway. R1 said S1 used one hand and grabbed both her breasts, under R1’s pajamas and that R1 told S3 about the incident the same day.
Staff and all residents were interviewed and denied ever seeing S1 or S2 abuse R1 as alleged. All staff and residents interviewed denied ever seeing or hearing about S1 touching R1 inappropriately.
Staff, S4, stated that S4 once observed R1 lay on the floor of their bedroom, deliberately rubbing their elbows back and forth on the carpet until R1’s elbows bled.
S1 and S2 were interviewed and denied physically abusing R1.
Available facility care notes were reviewed. On 11/30/2020, it was noted by staff in progress notes that staff asked R1 to take a phone call in their room, when staff heard R1 talking to their mom about wanting to move because "staff S1 drug her across the floor." R1 reportedly stated, "Ok, I won't lie anymore," and continued with the phone call in the living room and did not take the call to their bedroom.
Administrator S3 stated on 03/09/2021 (two days prior to the bruise being observed in the hospital), she saw R1 fall into her empty dresser, while standing in R1’s bedroom doorway. Documented care notes were reviewed and were consistent with S3’s statements.
Although R1 sustained an injury to their elbow and hip/back area, there is not enough evidence to substantiate that either injury was caused by staff handling R1 in a rough manner. Nor is there enough evidence to substantiate that S1 touched R1’s breasts.

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021

LIC9099 (FAS) - (06/04)

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Control Number 25-AS-20210311144929

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: HOLLIDAY HOMES LARKSPUR	FACILITY NUMBER: 525002162
	VISIT DATE: 07/22/2021

NARRATIVE

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Review of Red Bluff Police Department’s (RBPD) report found that on 03/11/2021 the department received a report by phone. It was alleged that R1 was being abused by staff at the facility and R1 continuously asks to move out. The caller also alleged R1 was being over medicated and ,lastly, that R1 had swallowed a battery and had been told they were lying by S3.
RBPD Officer responded to Holliday Homes-Larkspur at 1215 Larkspur Court, Red Bluff CA 96080 and spoke with Administrator (S3). S3 denied the allegations of abuse and stated staff do not restrain residents but must stand in front of the door to prevent escape attempts. Staff are encouraged to wear loose fitting clothes to prevent injuries to staff by residents. It was reported by S3 that R1, ay times, makes up events in hopes they can move closer to their mother and sister. S3 denied over medicating R1 and allowed RBPD officer to inspect R1’s Medication Administration Record (MAR). In regards to R1 swallowing a battery, S3 stated, once she was made aware and verified the information, R1 was taken to the hospital.
RBPD Officer interviewed all other residents at the facility and none said had seen any mistreatment of any resident by a staff.
RBPD Officer then responded to an area Hospital to speak with R1. R1 said S1 dragged R1 but did not say how R1 was dragged or give a date or time. R1 said they were upset because S1 would not let them play games. R1 said they did not want to live at Holliday House because they wanted to move back with their sister and mother because R1 missed them.
RBPD Officer spoke with S1 via telephone. S1 stated that R1 behaves badly to get removed from the facility and regularly attacks staff and other residents. When R1 acts out, staff instruct the other residents to go to their rooms and lock the doors. S1 holds a pillow between himself and R1 to prevent R1 from attacking him. S1 denied dragging R1 to their room.
The report concludes that based on his investigation and lack of evidence, RBPD Officer was unable to determine a crime occurred. The report is closed as unfounded.

R1 stated in interview on 6/1/21 that they receive their medications as directed. R1 further stated that they swallowed a battery while alone in their room because they no longer want to live at the facility.

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021

LIC9099 (FAS) - (06/04)

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Control Number 25-AS-20210311144929

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: HOLLIDAY HOMES LARKSPUR	FACILITY NUMBER: 525002162
	VISIT DATE: 07/22/2021

NARRATIVE

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R1 also stated the they sustained bruises to their back and hip when they lost balance and fell against their dresser. R1 does not require one-to-one staff assistance while in their room. R1 had no prior incidents of ingesting inappropriate objects.

As the alleged violations were not witnessed, R1 provided inconsistent statements and records did not show a violation The Department finds the allegations to be (US)Unsubstantiated - A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview with administrator. LPA had computer technical difficulties at the time of the visit. Report Copy was emailed to Licensee .

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021

LIC9099 (FAS) - (06/04)

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