<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 490108000
Report Date: 03/20/2025
Date Signed: 03/20/2025 11:13:06 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
12/10/2024 and conducted by Evaluator Christi Coppo
COMPLAINT CONTROL NUMBER: 21-AS-20241210103623
FACILITY NAME:MC HUGH CARE HOMEFACILITY NUMBER:
490108000
ADMINISTRATOR:DIZON, TIFFANYFACILITY TYPE:
740
ADDRESS:1000 GORDON LANETELEPHONE:
(707) 545-8213
CITY:SANTA ROSASTATE: CAZIP CODE:
95404
CAPACITY:15CENSUS: 8DATE:
03/20/2025
UNANNOUNCEDTIME BEGAN:
09:04 AM
MET WITH:Nick Aquino, licenseeTIME COMPLETED:
11:28 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff withheld medication from resident in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At approximately 9:00AM, Licensing Program Analyst (LPA) Christi Coppo arrived at this facility unannounced, to conduct an investigation into the above allegation. LPA met with caregiver. Nick Aquino arrived later but then left. He gave caregiver permission to sign.

Complaint alleges staff withheld medication from resident in care. Complainant alleges that resident (R1) was not given their morphine medication on the morning of their death. Complainant alleges that the medication was purposefully withheld due to the staff’s (S1 and S2) religious beliefs. During investigation, LPA interviewed outside party that suspected morphine was not given per orders on the morning of resident (R1) death. Per interview on 3/20/25, S2 advised LPA that giving morphine is a mortal sin, as they are a practicing Catholic and they will not give that medicine becuase residents might die from receiveing it.


Continued on 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025
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-20241210103623
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: MC HUGH CARE HOME
FACILITY NUMBER: 490108000
VISIT DATE: 03/20/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Continued from 9099...

However, per interview on 12/20/24 with S1, LPA was advised that R1 did receive the necessary morphine on the morning of R1's death. S2 advised LPA that S1 gave R1 the morphine that morning, and because of this being a mortal sin, S1 later went to confession to confess the sin and ask for forgiveness.

During investigation, LPA conducted interviews. LPA did not receive any reports of medication being withheld or observing any medications being withheld from residents.

LPA asked for medical destruction record and MAR for the administration of morphine for R1. Facility could not produce the morphine medical destruction record for R1. LPA attempted to verify medication administration and destruction records with hospice company but was unsuccessful. So, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted with caregiver. A copy of this report given. No deficiencies cited.

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2