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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 525002751
Report Date: 06/20/2023
Date Signed: 06/20/2023 10:03:22 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/06/2023 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 59-AS-20230406094137
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:
06/20/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Cathryn Russell - house managerTIME COMPLETED:
10:15 AM
ALLEGATION(S):
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Facility not addressing resident's health condition.
INVESTIGATION FINDINGS:
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06/20/2023 09:30 AM Licensing Program Analysts (LPAs) Rebecca Knight and Jaynae Boyles 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
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
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 6
Control Number 59-AS-20230406094137
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: D & S CARE HOMES, LLC
FACILITY NUMBER: 525002751
VISIT DATE: 06/20/2023
NARRATIVE
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Facility not addressing resident's health condition - SUBSTANTIATED

It was reported that Client 1 (C1) attended day program on 03/27/2023 and 04/03/2023 even though they had conjunctivitis.

LPA review of physician’s note dated 04/06/2023 confirms that Client 1 (C1) had been diagnosed with conjunctivitis (pink eye) on that date.

Client 1 (C1) stated the doctor didn’t say they had pink eye but it was assumed. C1 stated their doctor gave them drops. C1 stated they went to day program when they had pink eye though C1 knew they should not have gone to day program.

1 of 2 facility staff stated that C1 had pink eye. 2 of 2 facility staff stated that C1 was asked to stay home from day program but went to day program anyways.

Licensee stated C1 did get a diagnosis after the fact. C1 was taken to their doctor and was diagnosed on 4/06/2023. C1 was supposed to stay home, it was an error on the facility’s part. All of the staff knew C1 was not supposed to go to day program.

It was determined that on the dates of 3/28/2023 and 04/03/2023 C1 attended day program when they had conjunctivitis and did not see their doctor until 4/06/2023 at which time they were diagnosed with conjunctivitis.

Based on interviews and evidence obtained during the investigation, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22), is being cited on the attached LIC9099D. Appeal rights were provided. Exit interview was conducted and the report was provided to licensee David Bortz.

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

DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 59-AS-20230406094137
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: D & S CARE HOMES, LLC
FACILITY NUMBER: 525002751
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/05/2023
Section Cited
CCR
80075(a)
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80075 (a) The licensee shall ensure that each client receives necessary first aid and other needed medical or dental services, including arrangement for and/or provision of transportation to the nearest available services. This requirement is not met as evidenced by:
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Licensee agrees will provide training for all staff regarding the understanding of regulation 80075 (a) and shall submit training content and signed staff attendance sheets to LPA as proof as proof of correction
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Based on interviews and document review it was determined that even though C1 was exhibiting symptoms of conjunctivitis on 3/27/2023, C1 was not taken to be examined by their physician until 4/06/2023. C1 attended their day program on 3/27/2023 while potentially contagious. This poses a potential health and safety risk to residents in care.
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The proof of correction is to be received by LPA Knight by 07/05/2023.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/06/2023 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 59-AS-20230406094137

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: DATE:
06/20/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:TIME COMPLETED:
10:15 AM
ALLEGATION(S):
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3
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9
Facility is not addressing the resident's hygiene issue.
Facility refusing to pick up resident during an emergency.
INVESTIGATION FINDINGS:
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06/20/2023 09:30 AM Licensing Program Analysts (LPAs) Rebecca Knight and Jaynae Boyles 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: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 59-AS-20230406094137
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: D & S CARE HOMES, LLC
FACILITY NUMBER: 525002751
VISIT DATE: 06/20/2023
NARRATIVE
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Facility is not addressing the resident's hygiene issue - UNSUBSTANTIATED

LPA review of C1’s LIC602 Physician’s Report revealed that C1 is voluntarily incontinent.

Client 1 (C1) stated they tried to hold it (urine) but they soaked their pull-up when they were heading to day program.

2 of 2 facility staff stated that C1 has behavioral incontinence. 1 staff stated that C1 did not bring their change of clothes with them that day because they knew they were not supposed to go to program.

Day program staff stated C1 didn’t bring their change of clothes with them to program. C1 has accidents about three times a day when they attend program.

Licensee stated That is a behavior of his, C1 is voluntarily incontinent. The day program was made aware this behavior before C1 started attending. It’s a fine line between what we can make C1 do and his personal rights.

It was determined that C1 is voluntarily incontinent. C1 had an episode of incontinence during transport to day program that day. C1 attended program without bringing their change of clothes with them that day. This allegation is unsubstantiated.

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

DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 59-AS-20230406094137
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: D & S CARE HOMES, LLC
FACILITY NUMBER: 525002751
VISIT DATE: 06/20/2023
NARRATIVE
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Facility refusing to pick up resident during an emergency - UNSUBSTANTIATED

Client 1 (C1) stated that staff picked them up from day program when they found out C1 had pink eye. C1 stated it took staff about one hour to pick them up from day program.

Staff 1 (S1) stated they were not in a position where they could pick up C1 from day program because there are other clients in the facility that are a fall risk and S1 could not get them in and out of their car. Staff 2 (S2) stated they went and picked C1 up about 1 hour after the day program contacted them.

Day program staff stated the house staff said they could not leave; they didn’t refuse but had other clients in the facility that they could not transport with them to come and pick C1 up.

Licensee stated S2 said she could pick C1 up so the facility staff would not have to leave. S2 asked if she could pick him up around noon because that was the soonest she could get there. Day program staff said that was OK. They put C1 in a room by themselves working on crafts until S2 got to day program to pick C1 up.

It was determined that S1 could not pick up C1 from day program because there are other clients in the facility that could not be transported in S1’s car. S2 was contacted and they picked up C1 from day program about 1 hour after being contacted by the day program. During the time that C1 was waiting they were isolated from other clients. 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: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 6