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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496803856
Report Date: 09/09/2025
Date Signed: 09/09/2025 05:10:46 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
09/02/2025 and conducted by Evaluator Christi Coppo
COMPLAINT CONTROL NUMBER: 21-AS-20250902101530
FACILITY NAME:OUR HOME LLCFACILITY NUMBER:
496803856
ADMINISTRATOR:ALBANO, KATHLEENFACILITY TYPE:
740
ADDRESS:2364 MELBROOK WAYTELEPHONE:
(707) 527-9390
CITY:SANTA ROSASTATE: CAZIP CODE:
95405
CAPACITY:6CENSUS: 6DATE:
09/09/2025
UNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Kathleen Albano, AdminstratorTIME COMPLETED:
05:25 PM
ALLEGATION(S):
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Prohibited health condition is not being handled by a licensed skilled professional
Facility Administrator is not present at the facility a sufficient amount of time.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christi Coppo conducted an unannounced visit and met with Administrator Kathleen Albano. LPA came to the facility to open an investigation into complaint allegations listed above.

Complaint alleges that prohibited health condition is not being handled by a licensed skilled professional. Complaintant states that both family and Administrator are not always present to do the feedings, so sometimes resident is not fed or staff is feeding R1 via PEG. Resident R1 required feeding via a PEG tube, which is a prohibited condition. R1 was with Anchor hospice, was discharged from Anchor, and now is back on hospice with Sutter.

During investigation, LPA reviewed Anchor hospice care plan. Care plan does not specify the parties responsible for the feedings. LPA asked Admin how she knew on what day and what time the family was available to adminisiter the feedings. Admin answered that they communcated everthing verbally.


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

DATE: 09/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2025
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-20250902101530
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: OUR HOME LLC
FACILITY NUMBER: 496803856
VISIT DATE: 09/09/2025
NARRATIVE
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Continued from 9099...

Admin reported that there were times that R1 missed feedings. LPA asked Admin if she had a calendar which indicated on what days and times the family would be responsible for the feedings. Admin could not produce any calendar for LPA. Admin was not able to provide any documentation to show who was feeding the resident. Staff and Admin both denied that staff ever fed R1 food via the PEG and interviews with witnesses reported to LPA that staff never fed R1. However, LPA did receive accounting that staff did feed R1 via PEG approximately 3-4 times, but LPA unable to corroborate accounting.

Complaint alleges that facility Administrator is not present at the facility a sufficient amount of time. During investigation LPA conducted interviews. It was reported to LPA that Admin has been present at facility between 75%-90% of the time when witnesses were present at the facility or when witnesses called. All witnesses report that Admin is available at all times of the day and week, via text and telephone. Admin advised LPA that she is present at the facility Monday through Friday from 7am to at least 3pm.

So, although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2