496803860-10-3-2024-21-AS-BMOS-DBEQ26-20241127104636

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803860
Report Date: 10/03/2024
Date Signed: 10/03/2024 05:44:00 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
09/17/2024 and conducted by Evaluator Dina Alviso

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20240917161619

FACILITY NAME:	CLEARWATER AT SONOMA HILLS		FACILITY NUMBER:	496803860
ADMINISTRATOR:	MCCARRON, KATHLEEN		FACILITY TYPE:	740
ADDRESS:	710 ROHNERT PARK EXPRESSWAY E		TELEPHONE:	(707) 710-7385
CITY:	ROHNERT PARK	STATE: CA	ZIP CODE:	94928
CAPACITY:	114	CENSUS: 94	DATE:	10/03/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Janice Foster-Health Services Director		TIME COMPLETED:	05:45 PM

ALLEGATION(S):

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Residents laundry not being done due to a broken washing machine
Facility did not seek timely medical

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alviso conducted a complaint inspection, on 10/3/2024 at approximately 9:00am, and met with Executive Director James Homer, and Health Services Director/LVN Janice Foster.

LPA toured the facility, including the memory care unit; LPA reviewed resident (R1) records, including medical documentation, and reviewed facility records. LPA conducted interviews with staff (S2, S3, S4, S5, S6), and with other related parties. LPA obtained conflicting information regarding allegations of "residents laundry not being done due to a broken washing machine, and facility did not seek timely medical". Per record reviews and interviews, the investigation revealed that R1 had a care plan in place, and the resident was on a shower schedule, and a laundry schedule. Per interviews with staff (S2) the memory care machines are currently both working well. Approximately six months ago one of the machines had to have the lock lid switch replaced, when the lid closed it would lock and immediately unlock which prevented the load from washing. The part was ordered and the machine was out of use until repaired, but the second washing machine still worked. The facility also has two larger laundry rooms in the assisted living area that staff can use to wash laundry loads as needed for the memory care residents.
Continued on LIC9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024

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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Control Number 21-AS-20240917161619

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: CLEARWATER AT SONOMA HILLS	FACILITY NUMBER: 496803860
	VISIT DATE: 10/03/2024

NARRATIVE

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The facility was never not able to wash laundry, as the facility has multiple washing machines. Staff interviewed (S3, S4, S5, S6) stated that memory care residents soiled clothing and/or linens are pulled each day as needed, and washed and dried that day. All other dirty laundry is done by the laundry schedule, a specified day in the week for each resident group. Per investigation, it is unknown if there was some laundry that wasn't washed as needed by staff and/or if dirty laundry was mixed in with clean clothes by a resident.

S2 stated that no staff purchases laundry soap because we have the eco lab soap bags attached that will automatically put soap in the washing machine to wash the load. If a resident wants to use a different laundry soap they may purchase other detergent and use that instead. No staff in AL or memory care are ever required to purchase soap/detergent to wash any of the resident/facility laundry.

Per record reviews and interviews, R1 didn't have any infections and/or observed need; Per interviews and record reviews, R1 was provided assistance if needed with toileting. R1's room had already been vacated, and no odors were noted and/or observed in the room when inspected. Per record reviews, and interviews, from move-in, R1 would wander around when getting up in the night; R1 would take everything in their room and move it onto the floor, and into the hallway. Staff would put everything back and redirect the resident as needed. Resident didn't have any diagnosed urinary tract infections while residing in the facility per record reviews and interviews. Per interviews, there were no observed symptoms and/or foul urine odor of a possible infection. Per investigation and review of records, including medical records, it is unknown if R1 had started an infection prior to leaving the facility and/or if the resident started it after moving out of the facility. There was no information obtained to support that violations had occurred regarding the allegations reported.

Based on the interviews, record/document reviews, and related information obtained during the investigation, the allegations "residents laundry not being done due to a broken washing machine, and facility did not seek timely medical” are 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.

No deficiencies cited.
Exit interview was conducted with the Executive Director James Homer.

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024

LIC9099 (FAS) - (06/04)

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