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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 216801977
Report Date: 12/29/2022
Date Signed: 12/29/2022 10:19:21 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 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
11/04/2022 and conducted by Evaluator Victoria Bertozzi
COMPLAINT CONTROL NUMBER: 21-AS-20221104150653
FACILITY NAME:STOCKSTILL HOUSEFACILITY NUMBER:
216801977
ADMINISTRATOR:NATALIA MEYERSONFACILITY TYPE:
740
ADDRESS:12051 STATE ROUTE 1TELEPHONE:
(415) 663-0722
CITY:POINT REYES STATIONSTATE: CAZIP CODE:
94956
CAPACITY:8CENSUS: 7DATE:
12/29/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator, Natalia MeyersonTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Facility staff did not accurately maintain residents' records
Facility staff did not accurately manage residents' medications
INVESTIGATION FINDINGS:
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Licensing Program Analyst Bertozzi arrived unannounced to deliver findings regarding the above complaint allegations and met with Administrator, Natalia Meyerson.

Facility staff did not accurately maintain residents' records – Complaint alleges that facility did not have a way to receive updated medication orders due to the fax machine not working. Per interviews, the facility fax machine was not working due to a storm, so doctor’s offices and hospice agencies were directed to send faxes to an alternate fax machine. The person checking the alternate fax machine would then send the written order to the facility staff via email or text message. Information received during investigation revealed that a hospice resident was receiving multiple medication changes per day and the hospice agency had representatives coming to the facility more frequently due to concerns that the medication orders were not being received timely, however, LPA was unable to confirm whether there was a significant delay or that a medication order was not received based on interviews or record review.

Continued on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Bertozzi
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022
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 21-AS-20221104150653
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: STOCKSTILL HOUSE
FACILITY NUMBER: 216801977
VISIT DATE: 12/29/2022
NARRATIVE
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Continued from LIC9099

Staff did not have records of resident’s medications– Complaint alleges that the facility’s fax machine did not work causing delays in updated comfort care orders to hospice patients, may have contributed to medication errors and likely contributed to increased suffering for patients. No specific examples were provided with complaint allegation. LPA conducted interviews and reviewed medication records and was unable to confirm that a medication error occurred or that the resident suffered due to alleged medication errors.

A finding that the complaint allegations that Facility staff did not accurately maintain residents' records and Facility staff did not accurately manage residents' medications were unsubstantiated meaning that although the allegations may have happened there is not a preponderance of evidence to prove that the allegations occurred.

No deficiencies cited during this inspection.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Bertozzi
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2