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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496803311
Report Date: 12/30/2024
Date Signed: 12/30/2024 12:03:05 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
12/27/2024 and conducted by Evaluator Dina Alviso
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20241227145208
FACILITY NAME:PLATINUM RESIDENTIAL CARE HOMEFACILITY NUMBER:
496803311
ADMINISTRATOR:SHAUGHNESSEY, MERAFACILITY TYPE:
740
ADDRESS:1972 DENNIS LANETELEPHONE:
(707) 757-8607
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY:6CENSUS: 6DATE:
12/30/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Mera Shaughnessey-AdministratorTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility food supply is not sufficient to meet residents needs
Facility is violating residents rights
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alviso conducted an unannounced complaint inspection, on 12/30/24 at approximately 9:30am, and met with caregiver Litiana Tuioga. Caregiver contacted the facility Administrator, Mera Shaughnessey, who arrived shortly after to meet with the LPA.

The reporting party (RP) alleges that "facility food supply is not sufficient to meet residents needs, and facility is violating residents rights". LPA toured the facility, including looking at the food supply, perishable and non-perishable. LPA observed a sufficient supply of frozen meats, frozen vegetables, fresh perishables, lunch meats, cheese, fruits, vegetables, grains, noodles, and miscellaneous canned food supply. Interviews conducted with staff (S2, S3),stated that their is always enough food supply, and if anything is needed, staff notify the Administrator. The Administrator will get the food items to the facility that day. S3 stated that they may go borrow milk or some lettuce from their sister facility, if wanting it for something specific while waiting for the Administrator to bring the purchase of the requested items that day. S1 stated that staff notify them when perishable items are needed, due to shopping for these more often than the non-perishable items; Administrator stated the non-perishables will go bad faster then non-perishables, so we have to shop for these every week to two weeks as needed.
Continued on LIC9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2024
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-20241227145208
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: PLATINUM RESIDENTIAL CARE HOME
FACILITY NUMBER: 496803311
VISIT DATE: 12/30/2024
NARRATIVE
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S1 stated they have never told the facility staff to go borrow food supply items from their next door licensed facility. S1 stated there is a sufficient supply of food to feed the residents in care. S1 stated they buy groceries in bulk and many perishables every few weeks as needed. S1 stated that no staff have provided any personal food items as this is not required of them and/or expected. S1 stated the staff are not to purchase and/or provide any food items to the facility, S1 stated they purchase food items from Costco, and local grocery stores, as needed and required to meet residents needs. In review of pictures of residents when they have had a fall and/or some sort of injury or reaction to something, there was no information obtained and/or found that are violating residents rights. This information is shared between caregivers on duty and coming on shift regarding residents in care. S1 stated they have a staff only group message for information updates for staff on shift and coming on shift. Pictures are taken to send to the resident Physician if requested by the Doctor; One of the POAs of a resident wants all pictures of R1 when anything happens. There is never any facial pictures and/or any personal private area (s) pictures of residents that would violate personal privacy. S1 stated that residents are always treated with respect in all ways, the facility is not to violate personal rights of residents in care.

There was no information obtained and/or observed, from LPAs facility food inspection, and all conducted interviews, to support violations had occurred.

Based on the LPAs observations, conducted interviews, and related information obtained during the investigation, the allegations of "facility food supply is not sufficient to meet residents needs, and facility is violating residents rights". are Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

No deficiencies cited.
Exit interview was conducted with the Administrator Mera Shaughnessey.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2