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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803639
Report Date: 05/29/2024
Date Signed: 05/29/2024 12:15:38 PM

Document Has Been Signed on 05/29/2024 12:15 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:PEOPLE'S CARE CHARMIANFACILITY NUMBER:
496803639
ADMINISTRATOR/
DIRECTOR:		SEAWRIGHT, PATRICKFACILITY TYPE:
740
ADDRESS:5087 CHARMIAN DRTELEPHONE:
(707) 537-9795
CITY:SANTA ROSASTATE: CAZIP CODE:
95409
CAPACITY: 4CENSUS: DATE:
05/29/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Patrick Seawright, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:03 PM
NARRATIVE
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Licensing Program Manager Victoria Bertozzi and Licensing Program Analyst Christi Coppo conducted an informal office meeting, and met with Administrator, Patrick Seawright and John O'Brien District Manager (DM) for licensee and Michelle Mainez COO of licensee.

Informal meeting to address concerns identified by the Department during a recent Complaint Investigation.

DM indicated they had lots of meetings about this incident and agree that the course of action taken by Admin was not appropriate and they have addressed it with Admin. Going forward, the staff have all been retrained about communicating about residents' care needs in order to prevent residents from experiencing pain unaddressed. Admin wants it noted that there was not any malice or purposeful neglect to not get the medical attention for R1.

The complaint investigation revealed that a client was observed on with a “heat blister” on 2/12/2024 by facility staff. Staff documented the blister on the facility’s internal system and per interviews, Administrator was notified of the blister the same day. The Administrator did not seek medical treatment via the emergency room despite client presenting with a raised blister. Staff noted that on the NOC shift the client was “whining” during repositioning. On 2/13/2024, staff noted that they observed the blister had grown bigger, was red, and filled with liquid. Interviews conducted during investigation revealed that the blister ruptured on 2/14/2024. Administrator did not seek medical treatment via the emergency room when blister ruptured. LPM Bertozzi spoke with Administrator on 2/15/2024 around 2:00pm. Administrator told LPM that they had emailed the client’s doctor between 9:00am and 11:00am but was unsure if the doctor had responded. CCL staff advised the Administrator to seek emergency medical treatment for the client, but Administrator indicated that they were going to wait for the doctor to respond.

Continued on LIC809C

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE: DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
Document Has Been Signed on 05/29/2024 12:15 PM - It Cannot Be Edited


Created By: Christi Coppo On 05/29/2024 at 10:31 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: PEOPLE'S CARE CHARMIAN
FACILITY NUMBER: 496803639

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/30/2024
Section Cited
CCR
87405(d)(a)(1)

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87405(d)(a) - (d)The administrator shall have the qualifications specified... (1) Knowledge of the requirements for providing care and supervision appropriate to the residents.

This requirement is not met as evidenced by:
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Admin to self-certify on LIC9098 that they have read regulation 87405 and licensee to submit updated protocol procedures including appropriate responses to types of injuries and the related medical response necessary by plan of correction due date.
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Based on CCL complaint inspection, the licensee did not comply with the section cited above in that facility Administrator did not seek timely medical attention for resident R1, which posed an immediate health, safety, or personal rights risk to persons in care.
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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.
SUPERVISOR'S NAME:Victoria Bertozzi
LICENSING EVALUATOR NAME:Christi Coppo
LICENSING EVALUATOR SIGNATURE:
DATE: 05/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/29/2024


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: PEOPLE'S CARE CHARMIAN
FACILITY NUMBER: 496803639
VISIT DATE: 05/29/2024
NARRATIVE
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Continued from LIC809

LPM directed Administrator to call the doctor and notify the office staff to assist in expedited guidance from the doctor. Eventually, the client’s doctor directed the Administrator to seek emergency medical treatment, which they did on 2/15/2024 at approximately 4:54pm.

LPM spoke directly with Administrator regarding a perceived refusal on the part of the Administrator to seek medical attention for the client. Administrator disagreed that they refused and indicated that they were unsure how to proceed as the injury was not something that they have previously encountered.

Parties discussed the changes that facility has made to their protocols to ensure residents' needs are met timely as well as the interaction between the Administrator and CCL staff.

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Administrator. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.

Exit interview conducted with Administrator and a copy of this report was given.

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

DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
LIC809 (FAS) - (06/04)
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