570303745-1-31-2023-21-AS-KMOA-CNPNEK-20230203092402

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 570303745
Report Date: 01/31/2023
Date Signed: 01/31/2023 04:01:34 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/13/2023 and conducted by Evaluator Jill Nakagawa

COMPLAINT CONTROL NUMBER: 21-AS-20230113141513

FACILITY NAME:	FARMHOUSE, THE		FACILITY NUMBER:	570303745
ADMINISTRATOR:	ELIZABETH HALL		FACILITY TYPE:	772
ADDRESS:	24321 COUNTY ROAD 96		TELEPHONE:	(530) 753-1653
CITY:	DAVIS	STATE: CA	ZIP CODE:	95616
CAPACITY:	10	CENSUS: 10	DATE:	01/31/2023
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Ashley Murillo, Program Director		TIME COMPLETED:	04:01 PM

ALLEGATION(S):

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Staff are not qualified to administer medications to residents
Staff are not disposing of residents medicine cups after contamination
Staff are not wearing masks
Staff did not prevent cats from contaminating the kitchen
Staff are not sanitizing their hands before preparing food
Staff did not dispose of expired foods

INVESTIGATION FINDINGS:

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At approximately 1:30PM, Licensing Program Analyst (LPA) Jill Nakagawa arrived to this facility unannounced to continue investigation and deliver findings regarding the above allegations. LPA met with Program Director Ashley Murillo. Based on review of records, and LPA observations staff have been trained to administer medications. LPA observed multiple med passes by different staff and found proper protocols and found medicine cups are not shared. LPA observed staff wearing masks on multiple unannounced visits. There are cats on the premises, but they are managed well. There were pet food bowls on the floor by a window near dining area, but set away from the kitchen and food prep areas; so contamination from cats in kitchen area is prevented by staff. Soap, paper towels and gloves are available to staff and residents to use prior to and during food preparation, with signage about hand-washing at the kitchen sink. All these tools are available to promote safe food handling and hand sanitization, as required for staff for all food prep.

Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

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 21-AS-20230113141513

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: FARMHOUSE, THE	FACILITY NUMBER: 570303745
	VISIT DATE: 01/31/2023

NARRATIVE

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(Continued from 9099)
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LPA Nakagawa inspected the contents of refrigerators and freezer on several visits and found that all foods stored were not expired, and opened containers were all dated and stored in closed sealed containers or packaging.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

LIC9099 (FAS) - (06/04)

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