Complaint Investigation Report

216803577-12-16-2022-21-AS-KMOA-CNUVL5-20230208153120

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SANTA ROSA RO , 1450 NEOTOMAS AVENUE, STE. 100

This is an official report of an unannounced visit/investigation of a complaint received in our office on

12/14/2022 and conducted by Evaluator Victoria Bertozzi

COMPLAINT CONTROL NUMBER: 21-AS-20221214133305

Staff not providing adequate supervision to resident(s) in care

Licensing Program Analyst Bertozzi arrived unannounced to conduct a Complaint Investigation regarding the above allegation and met with Staff, Robinson Bermudez. LPA spoke with Administrator, Sheri Lott who gave permission for staff to sign report.

Staff not providing adequate supervision to resident(s) in care - LPA has reviewed reports from the facility of client, C1 eloping facility twice within the last weeks. Both times staff were unable to maintain line of sight supervision and C1 was returned to the facility by the police. Per discussion with Administrator, there is a meeting planned today to discuss the increased elopement behavior and how staff will ensure client safety.

Civil Penalties are being assessed in the amount of $250 due to a repeat citation issued for the same subsection in less than 12 months.

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.