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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496801090
Report Date: 11/24/2025
Date Signed: 11/24/2025 04:10:00 PM

Substantiated


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
09/04/2025 and conducted by Evaluator Dina Alviso
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20250904124021
FACILITY NAME:HANNA HOUSE RIDLEYFACILITY NUMBER:
496801090
ADMINISTRATOR:HANNA, DAVIDFACILITY TYPE:
740
ADDRESS:1840 RIDLEY AVENUETELEPHONE:
(707) 591-0980
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY:28CENSUS: DATE:
11/24/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Karrie Hanna-Resident Care CoordinatorTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff are not following resident's medication Physician order as required

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Alviso, conducted a complaint investigation,and met with Karrie Hanna, Resident Care Coordinator.

Reporting party alleges that "staff are not following resident's medication Physician order as required." The LPA reviewed resident (R1) records, including medication records. The LPA reviewed facility records, including medicationr assistance records for resident (R1). LPA conducted interviews with staff, and other related parties.

The investigation revealed that R1 has two medications that require blood pressure checks prior to providing the medication to the resident. One medication is provided once a day if able to be provided, and the second medication is provided three times a day if able to be provided; This medication is only provided if in-line with the Physician's order of the resident's blood presure reading, athe time the medication is to be given, per order. Resident's blood pressure checks are to be done while the resident (R1) is standing, per physician instructions. In review of medication records by the facility, there was no specific record information of the actual blood pressure of R1 when medications were said to have been given, and no record showing blood pressure reading, month, days, and time the medications were said to have been provided to the resident (R1).

Continued on LIC9099C..
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 11/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2025
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 3
Control Number 21-AS-20250904124021
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: HANNA HOUSE RIDLEY
FACILITY NUMBER: 496801090
VISIT DATE: 11/24/2025
NARRATIVE
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Per interviews with staff, S2 stated there was no record of blood pressure readings or every single day and time the medications were provided to the resident. S2 stated they didn't track the blood pressure readings. The resident R1 has the blood pressure readings in their book. R1 didn't return to the facility after going to the hospital on 9/5/25 due to not feeling well. LPA discussed regulation information regarding medications, medication assistance, and maintaining medication records appropriately and accurately to reflect medications are being provided to the resident as required/needed. Ensuring compliance with Dr's Orders, and Dr's instructions, including records to show medication is being provided as required.

Per investigation, facility failed to provide R1's medications per Physician orders as required. There was no record of blood pressure (BP) readings, no record of month/days, time, showing the medications were provided, and record of acceptable BP reading of R1. S2 stated they didn't track the blood pressure readings, staff would look at record of blood pressure readings from R1. Sufficient information obtained to support violations occurred regarding "staff are not following resident's medication Physician order as required." Allegation is Substantiated.

This deficiency will be cited, 87465(a)(4) Incidental Medical and Dental Care- A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: The licensee shall assist residents with self administered medications as needed, see LIC9099D.

The preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is being cited.
Failure to correct deficiencies by due dates, may result in additional deficiency citations and/or civil penalties being assessed.
Exit interview conducted with the Resident Care Coordinator, Karrie Hanna.
Appeal Rights provided.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 11/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 21-AS-20250904124021
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: HANNA HOUSE RIDLEY
FACILITY NUMBER: 496801090
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/25/2025
Section Cited
CCR
87465(a)(4)
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87465(a)(4) Incidental Medical and Dental Care- A plan for incidental medical and dental care shall be developed by each facility: The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Per investigation, facility failed to provide R1's medications per Physician orders as required. There was no record of blood pressure (BP) readings, no record of month/days, time, showing the medications were provided, and record of acceptable BP reading of R1.
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Licensee/Administrator to ensure that residents’ medications are provided as needed, per Physician’s orders. Ensure that records are documented and maintained when medications have specific instruction, such as within a blood pressure reading and/or not over or under a specific blood pressure reading. Ensure staff providing blood pressure checks are qualified to be able to provide blood pressure checks to a resident. Submit plan, 12/3/25, on ensuring future compliance with this regulation and submit how the facility will document, and track medications as needed, per instructions by Physicians.
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S2 stated they didn't track the blood pressure readings, staff would look at record of blood pressure readings from R1. This is a health & safety risk to residents' in care.
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Plan of correction should include information documented regarding providing medications, prior to providing and/or after providing them, per order. POC due 11/25/25.
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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: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 11/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3