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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496800208
Report Date: 05/19/2021
Date Signed: 05/19/2021 02:28:25 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/03/2021 and conducted by Evaluator Marisol Cuadra
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20210303090404
FACILITY NAME:OAK TREE RANCHFACILITY NUMBER:
496800208
ADMINISTRATOR:BAUMGARTNER, KELLIFACILITY TYPE:
740
ADDRESS:1482 OLIVET ROADTELEPHONE:
(707) 571-1122
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY:6CENSUS: 6DATE:
05/19/2021
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Kelli Baumgartner (Administrator)TIME COMPLETED:
02:00 PM
ALLEGATION(S):
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9
-Staff do not properly maintain the facility.
-Staff do not keep the facility free from odor.
INVESTIGATION FINDINGS:
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2
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5
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to deliver findings of a complaint investigation regarding the above allegations. LPA met with Administrator, Kelli Baumgartner, reviewed records and interviewed residents in care. The complaint allegations indicated Staff do not properly maintain the facility and Staff do not keep the facility free from odor. Reporting party alleged that facility had upon entering to resident’s rooms a strong stench of urine was apparent, though it was unclear where it was coming from. Based on interviews conducted on 4/27/21 with reporting party, the carpet in resident’s rooms had been cleaned up and urine smell problem had been resolved. On 5/19/21 LPA/Administrator toured the physical plant, the bedrooms appeared clean, free of odors, well organized and sanitary. Based on observations made and interviews conducted with staff, responsible parties and residents in care, LPA was unable to either prove or disprove the above allegations.
A finding that the complaint allegations “Staff do not properly maintain the facility” and “Staff do not keep the facility free from odor” are unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.
No deficiencies were cited as a result of this investigation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021
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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