525002751-7-16-2024-59-AS-LMUZ-D7N2A2-20240729171250

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 525002751
Report Date: 07/16/2024
Date Signed: 07/16/2024 08:46:08 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
03/06/2024 and conducted by Evaluator Donna Gurriere

COMPLAINT CONTROL NUMBER: 59-AS-20240306112346

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: 3	DATE:	07/16/2024
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	ALONDRA AGUILAR		TIME COMPLETED:	09:00 AM

ALLEGATION(S):

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Staff did not assist resident in a timely manner.
Staff did not treat resident with dignity and respect.

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 03/06/24. LPA Gurriere met with Alondra Aguilar , and explainedAthe purpose of the visit.

Staff did not assist resident in a timely manner.

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)

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Control Number 59-AS-20240306112346

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 will cry out for assistance because she has fallen. Several staff reported that when the resident calls for assistance they respond to her needs, as quickly as possible; however, sometimes they are assisting with another resident. It was reported that the resident is known for “Attention seeking,” and that several times when they have gone to assist, she is sitting on the toilet, sitting on her bed, and has purposefully been seen sliding to the floor from her bed.

Staff did not treat resident with dignity and respect.

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 a resident felt that she wasn’t being treated with dignity. Staff were interviewed and it was reported by all that it was felt that staff do treat the resident with dignity and respect. 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 by several staff persons that sometimes the resident is impatient when requesting assistance and she may have to wait a few minutes, depending on her needs, as staff are assisting with another resident.

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)

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