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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 525002751
Report Date: 07/16/2024
Date Signed: 07/16/2024 08:44:56 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, 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
02/16/2024 and conducted by Evaluator Donna Gurriere
COMPLAINT CONTROL NUMBER: 59-AS-20240216123003
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: 3DATE:
07/16/2024
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:ALONDRA AGUILARTIME COMPLETED:
09:00 AM
ALLEGATION(S):
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Staff made inappropriate comments to residents.
Staff did not assist resident with obtaining religious services.
INVESTIGATION FINDINGS:
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On 07/16/24 Donna Gurriere, Licensing Program Analyst (LPA) arrived at the facility unannounced to deliver final findings regarding a complaint that was received on 02/16/24. LPA Gurriere met with Alondra Aguilar, and explained the purpose of the visit.


Staff made inappropriate comments to residents.

During the interview process, the administrator, the nurse, regional center staff, four staff persons and the resident (Resident 1) were interviewed. Several documents were obtained to include the resident’s Individual Program Plan (IPP), Physician’s Report, Admission Agreement, Client Roster, Medication Administrative Record (MARs), staff names and telephone numbers.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Donna Gurriere
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2024
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 59-AS-20240216123003
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: 07/16/2024
NARRATIVE
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During the investigation, it was reported that the resident was preparing to take her shower and asked the staff person to get her a towel. It was stated that the towels are reachable for the residents to get for themselves. Several staff persons advised that the resident would like to live independently (confirmed through the IPP) and that the resident is encouraged to assist herself so that she can become more independent. It was reported that the resident was upset because the staff did not obtain the towel for her. Throughout the resident’s IPP, it states numerous times that the “Resident would like to be independent.” Staff were following the resident’s IPP.

In addition, it was reported that a staff person made an inappropriate comment to another resident. It was stated that the resident was asked to go to his room as the resident was yelling while playing with a cat and the cat was meowing loudly. The staff person stated that he did not want the cat to wake up the other residents and asked the resident to go to his room.

Staff did not assist resident with obtaining religious services.

During the interview process, the administrator, the nurse, regional center staff, four staff persons and the resident (Resident 1) were interviewed. Several documents were obtained to include the resident’s Individual Program Plan (IPP), Physician’s Report, Admission Agreement, Client Roster, Medication Administrative Record (MARs), staff names and telephone numbers.

During the investigation, it was reported that the resident informed an outside person that she wanted to attend religious services. The person stated that she contacted the facility and was told that the staff could not find anyone to come to the facility. The facility staff stated that they did try to get someone to meet with the resident. The outside person was able to contact a church and the church members were able to provide services to the resident at the facility. It was reported that after a few visits from the church members the resident refused any other religious service visits.

Although the above allegations mentioned may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and all of the above findings are Unsubstantiated.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Donna Gurriere
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2