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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803643
Report Date: 08/03/2023
Date Signed: 08/03/2023 05:20:20 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
05/12/2023 and conducted by Evaluator Dominic Tobola
COMPLAINT CONTROL NUMBER: 21-AS-20230512110034
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: 3DATE:
08/03/2023
UNANNOUNCEDTIME BEGAN:
04:13 PM
MET WITH:Consolacion Espra, Lead CaregiverTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Facility is not meeting resident's care needs
INVESTIGATION FINDINGS:
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On 8/3/2023, Licensing Program Analyst (LPA), Tobola arrived unannounced for the purpose of delivering complaint findings and was greeted by Lead Caregiver Staff, Consolacion Espra. Licensee, Rosauro Sabile was contacted but unable to attend visit. LPA Tobola toured the facility, interviewed staff, residents and outside parties, reviewed resident records and made observations during the course of the investigation.

Complaint alleges the facility is not meeting resident’s care needs for resident R1. Based on a review of resident’s (R1) physician’s report and care plan, it is not indicated that R1 requires the use of continence care items and also states that R1 can manage their own toileting needs. Upon observation and interviews with residents, staff and outside parties, LPA found that the facility utilizes continence care items for R1, including adult diapers and bed pads.
In addition, LPA conducted interviews with multiple outside parties who indicated that they observed resident R1 left in soiled disposable briefs, padding and bedding on multiple occasions.

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

DATE: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023
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 3
Control Number 21-AS-20230512110034
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: 08/03/2023
NARRATIVE
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Allegation, facility is not meeting resident’s care needs, 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

Deficiency cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 21-AS-20230512110034
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: 08/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/10/2023
Section Cited
CCR
87464(f)
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87464(f) - Basic services shall at a minimum include care and supervision as described in
Health and Safety Code section 1569.2(c). These requirements were not met as evidenced by: Based on a review of records, it is not indicated that R1 requires the use of continence care items. Based on
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Licensee agrees to conduct in-service training for all staff to follow facility care protocols to meet the residents care needs and supervision to change linens and continence care products. In addition, Licensee agrees to update resident R1's Physician's Report and Needs & Service Plan
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observations, interviews with residents, staff and outside parties, it was found that the facility uses disposable briefs and pads for R1 without documentation of needed use or care plan. In addition, outside parties had observed R1 left in soiled disposable briefs, pads and bedding on multiple occasions. This serves as an immediate health, safety or personal rights risk to residents in care.
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to clearly indicate the use of continence care products for R1. Signed training and updated Physician's Report and Needs & Service Plan are to be submitted to CCLD by POC date 8/10/2023. Completed training signed by staff to be sumbitted by POC date 8/4/2023.
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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: 08/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3