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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496801554
Report Date: 04/05/2024
Date Signed: 04/05/2024 01:24:15 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, 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
01/31/2024 and conducted by Evaluator Marisol Cuadra
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20240131172927
FACILITY NAME:SUNSET GARDENFACILITY NUMBER:
496801554
ADMINISTRATOR:RELOTA, MECHELLEFACILITY TYPE:
740
ADDRESS:1018 SUNSET AVE.TELEPHONE:
(707) 528-8512
CITY:SANTA ROSASTATE: CAZIP CODE:
95407
CAPACITY:6CENSUS: 5DATE:
04/05/2024
UNANNOUNCEDTIME BEGAN:
12:18 PM
MET WITH:Judith Martinez (staff)TIME COMPLETED:
01:39 PM
ALLEGATION(S):
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-Facility staff is isolating resident to their room.
-Facility staff do not ensure that the resident has an adequate amount of water.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a complaint investigation and deliver findings regarding the above allegations and met with staff Judith Martinez. Licensee was not able to come to the facility, but they were available over the phone and gave permission to staff to sign the report.

The Department received an allegation of facility staff isolating a resident in their room. Per Reporting party, the resident (R1) is considered bedridden, and they do not leave their room due to staff is not providing them with the opportunity to interact with the other residents in the home. Based on records review, the facility provided R1’s care plan dated 1/1/2024. According to R1’s care plan, facility staff and their responsible attempts to communicate with them by holding their hand. LPA also was provided with the facility activity calendar that does not include residents who have an ambulatory limitation to help with socialization with other residents in care.

Continued on LIC9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024
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-20240131172927
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: SUNSET GARDEN
FACILITY NUMBER: 496801554
VISIT DATE: 04/05/2024
NARRATIVE
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Continued from LIC9099...

On 2/6/2024, LPA conducted an unannounced visit and observed that the facility has an activity board that confirmed that it does not include specialized activities that includes residents who have mobility limitations. During the visit, LPA toured R1’s bedroom and observed that their room is shared with another resident (R2) for about a year. Based on confidential interviews conducted by LPA with staff (S1 & S2) and residents in care (R2 & R3), who expressed that they do have a variety of activities as walks, go out for lunch with their families, watch tv, bingo, etc. Based on records review, R1’s physician report dated 12/28/2023 indicates that R1 is non-verbal, requires assistance with turning or repositioning in bed and with their daily activities. Per Licensee, they were aware that admitting a resident in their condition will require them to provide specialized activities, the licensee indicated that they had been trying to enroll R1 in a physical therapy provided by home health, but it was refused by R1’s responsible party. LPA will address the lack of activities provided by the facility with case management. A finding that the complaint allegation of facility staff isolating a resident to their room occurs is unsubstantiated meaning that 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 allegation is UNSUBSTANTIATED.

Regarding allegations of facility staff do not ensure that the resident has an adequate amount of water. Per reporting party, the resident (R1) is not provided with an adequate amount of water. During the investigation, on 2/6/2024 LPA/staff toured the facility including bedrooms used by residents in care. During the tour of the physical plant LPA/staff observed in the shared bedroom for R1 and R2 both residents had a bottle of water on their night table. The bottles of water are half full and there are about 18 ounces of water in each resident's (R1 & R2) bottle. Based on records review, R1’s daily personal care worksheet for the month of January 2024, indicates that the facility had been assisting R1 with bathing, bowel, bedding change, brushing teeth, incontinence, dressing, mobility exercises, grooming, hand care and laundry. LPA obtained Santa Rosa Police Department records of two welfare visits conducted on 2/7/2024 event #SR40001279 and 3/8/2024 event #SR240002413, the findings obtained resulted in an unfounded case disposition. LPA attempted on various dates (3/18/24 at 12:52pm and 3/27/24 at 9:00am) to speak with R1’s responsible parties to gather additional information but was unsuccessful. A finding that the complaint allegation occurs of facility staff do not ensure that the resident has an adequate amount of water is unsubstantiated meaning that 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 allegation is UNSUBSTANTIATED. Exit interview conducted with Licensee over the phone and a copy of this report was given.

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024
LIC9099 (FAS) - (06/04)
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