496802052-10-20-2023-21-AS-BMOS-CX6TK8-20231101144732

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496802052
Report Date: 10/20/2023
Date Signed: 10/20/2023 02:31:42 PM

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
08/03/2023 and conducted by Evaluator Victoria Bertozzi

COMPLAINT CONTROL NUMBER: 21-AS-20230803103840

FACILITY NAME:	BETSY'S II RCFE		FACILITY NUMBER:	496802052
ADMINISTRATOR:	ALICDAN, LUNINGNING		FACILITY TYPE:	740
ADDRESS:	3101 BRUSH CREEK ROAD		TELEPHONE:	(707) 537-0399
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95404
CAPACITY:	13	CENSUS: 11	DATE:	10/20/2023
		UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Licensee, Luningning (Bot) Alicdan		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Staff physically abuses resident in care
Staff are not meeting resident's care needs
Staff speaks to resident in an inappropriate manner
Staff withholds food from resident
Staff does not properly check resident's blood sugar and administering insulin

INVESTIGATION FINDINGS:

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Licensing Program Analysts Victoria Bertozzi and Christi Coppo arrived unannounced to deliver findings regarding the above complaint allegations and met with Licensee, Luningning (Bot) Alicdan.

Staff physically abuses resident in care – Complaint alleges that Licensee handled a resident roughly by tugging, pushing, pulling and kicking a resident. Complaint also alleges that a staff threw a resident across the room. LPA conducted interviews with noted resident(s) and other potential witnesses but was unable to confirm through interviews whether staff handled a resident roughly.

Staff are not meeting resident's care needs – Complaint alleges that facility provides “constipating meals” so that residents will have less frequent bowel movements and therefore less incontinence brief changes, Complaint also alleges that residents are only given one incontinence brief per day.

Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Bertozzi
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 21-AS-20230803103840

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: BETSY'S II RCFE	FACILITY NUMBER: 496802052
	VISIT DATE: 10/20/2023

NARRATIVE

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Continued LIC9099

Per interviews, residents are provided meals with fruits and vegetables. LPAs observed sufficient incontinence products for residents and per interviews, residents are able to communicate when they need their incontinence brief changed. LPA was unable to confirm through interview that residents are not being provided regular incontinence care.

Staff speaks to resident in an inappropriate manner – Complaint alleges that Licensee spoke to a resident in a loud, rude and disrespectful way. LPA interviewed multiple residents who did not report that staff spoke to them in a loud, rude or disrespectful manner.

Staff withholds food from resident - Complaint alleges that staff are instructed to not bring food to a resident “as punishment”. LPA conducted interviews and was unable to confirm that food is being withheld from residents.

Staff does not properly check resident's blood sugar when administering insulin – Complaint alleges that resident who is insulin dependent get their blood sugar tested and injection given by staff without staff properly cleaning the skin and not ensuring that resident is receiving the correct dose. Facility does not currently have a resident on insulin. Former insulin dependent resident was not available for interview. Regulation does not allow residents to receive an injection from someone who is not an appropriately skilled professional.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated.

No deficiencies cited during this inspection.

SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Bertozzi
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023

LIC9099 (FAS) - (06/04)

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