525002751-5-30-2023-59-AS-KHOS-CSJLU9-20230606090333

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 525002751
Report Date: 05/30/2023
Date Signed: 05/30/2023 01:28:54 PM

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
03/13/2023 and conducted by Evaluator Rebecca Knight

COMPLAINT CONTROL NUMBER: 59-AS-20230313155820

FACILITY NAME:	D & S CARE HOMES, LLC		FACILITY NUMBER:	525002751
ADMINISTRATOR:	BORTZ JR, DAVID L.		FACILITY TYPE:	735
ADDRESS:	760 MELTON COURT		TELEPHONE:	(530) 864-2341
CITY:	RED BLUFF	STATE: CA	ZIP CODE:	96080
CAPACITY:	4	CENSUS: 4	DATE:	05/30/2023
		UNANNOUNCED	TIME BEGAN:	01:08 PM
MET WITH:	Cathry Russell - house manager		TIME COMPLETED:	01:35 PM

ALLEGATION(S):

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Licensee did not administer medication to client as prescribed by client's physician. - UNSUBSTANTIATED
Staff are hostile toward client. - UNSUBSTANTIATED

INVESTIGATION FINDINGS:

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05/30/2023 1:10 PM Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with house manager Cathryn Russell. The purpose of this visit was to deliver the results of a complaint investigation.

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, MAR 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: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

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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Control Number 59-AS-20230313155820

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: 05/30/2023

NARRATIVE

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Licensee did not administer medication to client as prescribed by client's physician - UNSUBSTANTIATED

LPA review of C1’s LIC602 Physician’s Report revealed C1 cannot administer or store their own medications. LPA review of C1’s MARS sheet revealed that C1 was non-compliant with their AM medications on 3/02/2023, and 3/10/2023.

Client 1 (C1) was not interviewed. LPA visited the facility twice to interview C1 and C1 was unavailable both times.

4 of 5 staff stated that C1 refused their medications that morning. 1 staff stated that because of the shift they work they did not know whether C1 had refused their medications that morning.

Licensee stated C1 refused to take their medication. Licensee spoke to Staff 4 (S4) who said they tried to get C1 to take their medication several times and C1 continued to refuse.

It was determined that staff tried to get C1 to take their medications but C1 refused their medication. This allegation is unsubstantiated.

Staff are hostile toward client - UNSUBSTANTIATED

Client 1 (C1) was not interviewed. LPA visited the facility twice to interview C1 and C1 was unavailable both times. Complainant did not provide examples of staff being hostile toward C1.

During staff interviews it was learned that C1 does not like some of the staff and C1’s relationship with staff depends on the type of day that C1 is having. Staff gave no indication of hostility toward C1.

Licensee stated if C1 is getting what they want they are happy.

This allegation is unsubstantiated.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations 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: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

LIC9099 (FAS) - (06/04)

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