496804011-2-9-2023-21-AS-HDBI-CP62EY-20230217162042

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496804011
Report Date: 02/09/2023
Date Signed: 02/09/2023 09:35:41 AM

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
12/13/2022 and conducted by Evaluator Victoria Bertozzi

COMPLAINT CONTROL NUMBER: 21-AS-20221213085128

FACILITY NAME:	WINDSOR GOLDEN LIVING		FACILITY NUMBER:	496804011
ADMINISTRATOR:	ALCONES, ARTHUR O.		FACILITY TYPE:	740
ADDRESS:	65 BLUEBIRD DRIVE		TELEPHONE:	(707) 953-2161
CITY:	WINDSOR	STATE: CA	ZIP CODE:	95492
CAPACITY:	6	CENSUS: 4	DATE:	02/09/2023
		UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Licensee, Arthur Alcones.		TIME COMPLETED:	09:45 AM

ALLEGATION(S):

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Staff handled resident in a rough manner
Staff do not administer medications to residents as prescribed
Staff isolated residents to their rooms for an extended period of time
Staff do not provide residents with clean towels
Staff pressured resident for funds

INVESTIGATION FINDINGS:

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Licensing Program Analyst Bertozzi arrived unannounced to deliver findings regarding the above complaint allegations and met with Licensee, Arthur Alcones.

During investigation LPA conducted interviews, reviewed documents and made observations.

Staff handled resident in a rough manner – Complaint alleges that staff tried to force resident to undress by tying them down. Per interviews, resident R1 refused assistance with showering and getting dressed. Staff denied forcing a resident to undress as the resident chose to do those tasks independently without assistance from staff. An incident was described by staff where resident requested a bandaid but would not allow staff to see their wound. Per interview, staff asked multiple times to assess resident due to concern for their health and safety but resident refused.

Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Bertozzi
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

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-20221213085128

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: WINDSOR GOLDEN LIVING	FACILITY NUMBER: 496804011
	VISIT DATE: 02/09/2023

NARRATIVE

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Continued from LIC9099C

Staff do not administer medications to residents as prescribed – Complaint alleges that the facility over medicates the resident by doubling their medication and that all residents are prescribed sedatives. Per staff interviews, R1’s medication dosage was doubled by their primary physician. Per LPA review of medication documents, R1 did have a medication doubled by their physician. LPA did not find evidence that all residents are prescribed a sedative.

Staff isolated residents to their rooms for an extended period of time – Complaint alleges that residents are made to go to bed and that there is a resident who staff will not allow to leave their room. Per staff interviews, residents are encouraged to come out of their room and there is not a requirement that they go to bed at a certain time. Per interview with identified resident, they choose to stay in their room and denied that staff force them to stay in their room.

Staff do not provide residents with clean towels – Complaint alleges that staff only provide residents with one towel and if another towel is requested, staff will pick up a dirty towel from the floor and hang it up again for the resident. Per staff interviews, residents are given a clean towel each day and residents are not denied additional towels.

Staff pressured resident for funds – Complaint alleges that staff took another resident to the bank to pressure them for money. Per interview with Licensee, they drove the identified resident to the bank as a courtesy and they did not pressure the resident for money.

A finding that the complaint allegations that Staff handled resident in a rough manner, Staff do not administer medications to residents as prescribed, Staff isolated residents to their rooms for an extended period of time, Staff do not provide residents with clean towels and Staff pressured resident for funds were unsubstantiated meaning that although the allegations may have happened there is not a preponderance of evidence to prove that the allegations occurred.

No deficiencies cited.

SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Bertozzi
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

LIC9099 (FAS) - (06/04)

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