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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 08:48:58 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
03/20/2024 and conducted by Evaluator Donna Gurriere
COMPLAINT CONTROL NUMBER: 59-AS-20240320160004
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):
1
2
3
4
5
6
7
8
9
Medication Management.
INVESTIGATION FINDINGS:
1
2
3
4
5
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9
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13
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 03/20/24. LPA Gurriere met with Alondra Aguilar, and explained the purpose of the visit.


Medication Management.

During the interview process, the administrator, two staff persons, the nurse, and the regional center coordinator 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-20240320160004
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, as mentioned the resident’s MARs were reviewed. The strongest pain medication prescribed by the physician was Tylenol 500 mg. It was also noted that the resident is allergic to some pain medications. The physician prescribed the resident various types of medication and per the MARs, the staff persons were providing and following the dosages as prescribed. It was reported that the resident went to the hospital frequently in an effort to obtain medication that was stronger than Tylenol 500 mg.

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.



Note: This complaint initially had two allegations, Medication Management and Eviction. The Eviction allegation was determined to be Unfounded, as the resident was never served with an eviction notice. The report was completed on 03/21/24.
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