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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803653
Report Date: 12/17/2024
Date Signed: 12/17/2024 10:14:16 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/05/2024 and conducted by Evaluator David Leibert
COMPLAINT CONTROL NUMBER: 21-AS-20241105153420
FACILITY NAME:ROCKVILLE TERRACE SENIOR LIVINGFACILITY NUMBER:
486803653
ADMINISTRATOR:CAROL DOWELLFACILITY TYPE:
740
ADDRESS:4625 MANGELS BLVDTELEPHONE:
(707) 862-2222
CITY:FAIRFIELDSTATE: CAZIP CODE:
94534
CAPACITY:199CENSUS: 152DATE:
12/17/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Carol DowellTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Staff did not assist resident with transportation needs.
Staff did not assist resident with care needs in a timely manner.
Staff threatened resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst Leibert arrived unannounced for the purpose of delivering findings on this complaint. LPA met with **** and discussed the disposition. Complainant has alleged that facility staff are not responsive to Complainant's needs and cites having to wait for transportation to appointments, not responding timely to calls for assistance and making threatening remarks to Complainant. This investigation included a review of documents and taking of statements from parties and witnesses. Facility staff deny the allegations. A review of the facility policy regarding transportation for residents suggests that reasonable accommodations are made for the residents, including the Complainant. Complainant did not initially provide a date that staff did not respond in a timely manner and, when pressed, gave a date subsequent to the lodging of this complaint. This investigation found no evidence that staff have threatened the Complainant but did determine that exceptional efforts were made to accommodate Complainant's preference for particular staff to provide housekeeping services. Although the allegation may be true, based upon the review of documents and statements provided, there is not a preponderance of evidence to prove, or disprove, the allegations. Therefore, the complaint is UNSUBSTANTIATED. Report left.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carla Martinez
LICENSING EVALUATOR NAME: David Leibert
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
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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