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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 525002751
Report Date: 05/05/2023
Date Signed: 05/05/2023 09:44:57 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/10/2023 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 25-AS-20230210160611
FACILITY NAME:D & S CARE HOMES, LLCFACILITY NUMBER:
525002751
ADMINISTRATOR:BORTZ JR, DAVID L.FACILITY TYPE:
735
ADDRESS:760 MELTON COURTTELEPHONE:
(530) 864-2341
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY:4CENSUS: 4DATE:
05/05/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Kathryn Russell - house managerTIME COMPLETED:
09:45 AM
ALLEGATION(S):
1
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9
Staff verbally abuse resident - UNSUBSTANTIATED
INVESTIGATION FINDINGS:
1
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5
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05/05/2023 09:15 AM Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with aKathryn Russell - house manager. The purpose of this visit was to deliver the results of a complaint investigation. Prior to initiating the visit, LPA completed a self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms.

During the course of the investigation the licensee, and 5 staff were interviewed. LPA requested and reviewed the following documents: related incident reports, Physician’s report, Admission Agreement, IPP for 1 client, staff list with telephone numbers, client list.

Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023
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
Control Number 25-AS-20230210160611
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME: D & S CARE HOMES, LLC
FACILITY NUMBER: 525002751
VISIT DATE: 05/05/2023
NARRATIVE
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Staff verbally abused client - UNSUBSTANTIATED

Client 1 (C1) was not interviewed. LPA visited the facility twice to interview C1 and C1 was unavailable both times. Per complainant when asked, C1 could not provide examples of staff verbally abusing C1.

5 of 5 staff stated that C1 had not told them that a staff member had been verbally abusive toward C1. 5 of 5 staff stated they had not witnessed any staff being verbally abusive toward C1.

Licensee stated C1 has told him that staff are snide toward C1 and don’t listen to C1. When C1 makes these types of complaints the facility has a protocol that they follow which includes talking to the caregiver to find out what happened, notifying C1 that the caregiver has been spoken to, then following up with C1 to see if there are more issues.

This allegation is unsubstantiated.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are UNSUBSTANTIATED.

An exit interview was conducted. A copy of the report was provided to licensee David Bortz.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023
LIC9099 (FAS) - (06/04)
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