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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496803807
Report Date: 08/25/2025
Date Signed: 08/25/2025 05:29:57 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
08/20/2025 and conducted by Evaluator Dina Alviso
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20250820140658
FACILITY NAME:COGIR OF ROHNERT PARKFACILITY NUMBER:
496803807
ADMINISTRATOR:ORDING, KELLYFACILITY TYPE:
740
ADDRESS:4855 SNYDER LANETELEPHONE:
(707) 585-7878
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY:75CENSUS: DATE:
08/25/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Kelly Ording-AdministratorTIME COMPLETED:
05:40 PM
ALLEGATION(S):
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Staff did not provide toileting needs to resident

Staff did not address residents' change in condition

Staff did not seek needed medical attention for residents'
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alviso conducted a complaint inspection, on 8/25/25 at approximately 9:45am, and met with the Administrator, Kelly Ording, LPA met with new Health & Wellness Director

Reporting party alleges "staff did not provide toileting needs to resident, staff did not address residents' change in condition, staff did not seek needed medical attention for residents". LPA reviewed residents',
R1 and R2, records, including care plan, progress notes, medication records, and medical documentation.
LPA conducted interviews with staff, S1, S2, and S3, and other related parties, regarding allegations. LPA obtained copies of records.

Investigation revealed R1 is able to communicate needs to staff, per medical assessment. Per file review of records, and interviews, resident R1's care needs for incontinence are being met by care staff and med-technicians.

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

DATE: 08/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2025
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-20250820140658
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: COGIR OF ROHNERT PARK
FACILITY NUMBER: 496803807
VISIT DATE: 08/25/2025
NARRATIVE
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Per review of records, interviews conducted, progress notes and medical documentation reviewed, caregivers and medication- technician staff, addressed resident incidents of R1 as needed, assisting with toileting/incontinent needs, providing needed care, per care plan, and contacting 911 when needed, per review of records. Resident R1 went out 911 on 7/24/25 due to weakness, and pain; and R1 returned to the facility on 7/28/25. Facility staff called 911 for R1 on 7/31/25 due to continued decline with pain and weakness, per file reviews and interviews. R1 returned on 8/22/25 on hospice care services.

Investigation revealed R2 is able to communicate needs to staff, per medical assessment. Per file review of records and interviews, resident R2 has prescribed pain medications for chronic pain/health diagnosis; The pain medications are to be provided to the resident as ordered, some pain medications are daily dosed/regularly provided specific times, and others are provided as needed. Per review of medication records, and resident progress notes, R2's pain medications are provided to R2 as prescribed. R2 receives incontinent care per review of records. R2 went out 911 on 8/22/25 due to complaints of pain, and difficulty breathing. Staff caregiver/medication- technician observed the need for the resident to be assessed by a medical professional, 911 was called and emergency response transferred resident to the ER. Per interviews, R2 receives assistance with medications when requested by the resident, and as ordered by the Physician. Per interviews, R2 receives needed care and assistance, per care plan, needs, and observations.

The investigation revealed that there was differing information obtained from information provided to the Department regarding the allegations. There was no information obtained that supported the violations had occurred.

Based on LPAs observations, record reviews, interviews with staff, and information obtained from other related party(s) there is insufficient information to prove or disprove the allegation of "staff did not provide toileting needs to resident, staff did not address residents' change in condition, and staff did not seek needed medical attention for residents". Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.

No deficiencies cited.
Exit interview conducted with Kelly Ording, Administrator.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2