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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 08:47:43 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
03/14/2024 and conducted by Evaluator Donna Gurriere
COMPLAINT CONTROL NUMBER: 59-AS-20240314081440
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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Licensee did not transport resident back from hospital.
Staff spoke inappropriately to a resident.
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 03/14/24. LPA Gurriere met with Alondra Aguilar, and explained the purpose of the visit.

Licensee did not transport resident back from hospital.

During the interview process, the administrator, two staff persons, the nurse, and two regional center staff persons were interviewed. The resident (Resident 1) was not interviewed as she has since moved. 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-20240314081440
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 (R1) is not conserved, and was independent in her transportation, as she took TRAX (bus service), ambulance transportation, hospital services transportation, facility transportation and at times an UBER (vehicle service). The resident was very high functioning, and it was not uncommon for the resident to get herself to her various weekly medical appointments, hospital appointments and outings.

An incident report was submitted to the licensing agency and stated that shortly after midnight, on 03/12/24 the resident contacted Emergency Services (911) to go to the hospital due to pain. The hospital staff advised the resident to come to the hospital if she was in need. It was reported that the hospital had the resident wait in the waiting room for an open bed. Once the resident was seen, she was given pain medication and discharged after 4:00 a.m.

The administrator stated that because the resident is highly functioning and independent and not conserved, the resident knows to contact the facility when she has a need or needs a ride. The facility staff stated that they were not notified to come and pick the resident up from the hospital. The regional center staff reported that the facility staff have been very responsible in trying to work with the resident.

Staff spoke inappropriately to a resident.

During the interview process, the administrator, two staff persons, the nurse, and two regional center staff persons were interviewed. The resident (Resident 1) was not interviewed as she has since moved. 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 has numerous behavioral issues and was seeking to be independent in her living situation. Staff reported that they assist the resident; however, also try to encourage her to be self-reliant as much as possible. It was stated that the resident becomes impatient with the staff when they are not immediately available to assist her.

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