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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803643
Report Date: 03/14/2023
Date Signed: 03/14/2023 02:55:27 PM

Substantiated


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
11/16/2022 and conducted by Evaluator Dominic Tobola
COMPLAINT CONTROL NUMBER: 21-AS-20221116095116
FACILITY NAME:SABILE HOUSE OF CAREFACILITY NUMBER:
486803643
ADMINISTRATOR:SABILE, ROSAUROFACILITY TYPE:
740
ADDRESS:388 VALLE VISTA AVENUETELEPHONE:
(707) 315-1941
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY:6CENSUS: 5DATE:
03/14/2023
UNANNOUNCEDTIME BEGAN:
10:16 AM
MET WITH:Rosauro Sabile, LicenseeTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Resident is inappropriately restrained
INVESTIGATION FINDINGS:
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On 3/14/2023 Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of delivering complaint investigation findings. LPA toured the facility, interviewed staff, residents, reviewed resident records and made observations.
Complaint alleges that resident is inappropriately restrained. Based on interview, Licensee stated that resident (R1) uses a lap belt harness within their wheelchair to prevent resident from falling. Based on a review of R1's medical records LPA found that R1 does not have a documented physician orders on file allowing the use of the lap belt. Allegation, resident is inappropriately restrained is found to be SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.
The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. Appeal Rights Given
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
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 4
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
11/16/2022 and conducted by Evaluator Dominic Tobola
COMPLAINT CONTROL NUMBER: 21-AS-20221116095116

FACILITY NAME:SABILE HOUSE OF CAREFACILITY NUMBER:
486803643
ADMINISTRATOR:SABILE, ROSAUROFACILITY TYPE:
740
ADDRESS:388 VALLE VISTA AVENUETELEPHONE:
(707) 315-1941
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY:6CENSUS: 5DATE:
03/14/2023
UNANNOUNCEDTIME BEGAN:
10:16 AM
MET WITH:Rosauro Sabile, LicenseeTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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8
9
Facility does not provide appropriate activities for residents
Facility failed to meet resident care needs
INVESTIGATION FINDINGS:
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On 3/14/2023 Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of delivering complaint investigation findings. LPA toured the facility, interviewed staff, residents, reviewed resident records and made observations.

Complaint alleges facility does not provide appropriate activities for residents. Based on observation and interview with residents (R1, R2 & R3) and Licensee, LPA found that residents participate in activities primarily including television game shows and use of stationary exercise equipment located in the living room.

Continued onto LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 21-AS-20221116095116
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: SABILE HOUSE OF CARE
FACILITY NUMBER: 486803643
VISIT DATE: 03/14/2023
NARRATIVE
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In addition, LPA observed residents listening to music or news with additional puzzles and word problem books available. In addition, residents R2 and R3 both stated that they prefer activities like radio, television, exercise and stretching with no complaints. Based on interviews, R1 stated that they "do not know" what activities they participate in. Licensee stated that residents previously attended day programs but have since closed. Licensee stated that they are working on integrating additional activities.

Complaint alleges that facility failed to meet resident care needs. Based on observation LPA found staff to be attentive and interactive with residents, providing continence care and general cleaning of resident bedrooms. Residents were observed to be communicative, comfortable and in positive demeanor. LPA observed breakfast and lunch served at the facility with generous portions and healthy items. LPA interviewed residents (R1, R2 & R3 all of which stated that the amount of food served is generous. R2 and R3 claimed that the food is served 3 times daily and enjoyable with snacks offered throughout the day. R3 stated that they do not know if they received snacks.

Based on interviews with staff and residents, LPA found that residents primarily receive sponge baths as opposed to showers. Licensee stated that the residents are offered regular baths but prefer sponge baths as residents often refuse bathing. LPA interviewed R2 who stated that residents are encouraged but does not like to take regular baths because of the work it takes for R2. R2 also stated that they prefer receiving sponge baths and have no complaints of staff neglecting continence care. LPA did not observe any foul smells or lack of continence care during inspections.

Allegations, facility does not provide appropriate activities for residents and facility failed to meet resident care needs are UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Appeal Rights given.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 21-AS-20221116095116
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: SABILE HOUSE OF CARE
FACILITY NUMBER: 486803643
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/15/2023
Section Cited
CCR
87608(a)(1)
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87608(a)(1) Postural Supports. Postural supports may be used to achieve proper body position and balance, improve mobility and independent functioning or to position rather than restrict movement. This requirement is not met as evidenced by**
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Licensee agrees to contact R1's physician and obtain orders for use of waist strap/belt. Once received, Licensee to submit exception request to CCLD. LIC9098 form is to be submitted to CCLD by 3/15/2023
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Based on interviews with Licensee and observations; LPA found that facility utilizes waist strap/harness for resident (R1) without physician's orders. This poses an immediate Health, Safety or Personal Rights risk to Clients in care.
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confirming contact with physician. Lastly, Licensee is to conduct a review of all residents' care needs and update Needs & Service Plans. Updated plans to be submitted to CCLD by POC date 3/24/2023.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4