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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496804011
Report Date: 12/09/2024
Date Signed: 12/09/2024 04:43:37 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
11/07/2024 and conducted by Evaluator Dina Alviso
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20241107111818
FACILITY NAME:WINDSOR GOLDEN LIVINGFACILITY NUMBER:
496804011
ADMINISTRATOR:ALCONES, ARTHUR O.FACILITY TYPE:
740
ADDRESS:65 BLUEBIRD DRIVETELEPHONE:
(707) 953-2161
CITY:WINDSORSTATE: CAZIP CODE:
95492
CAPACITY:6CENSUS: 5DATE:
12/09/2024
UNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Arthur Alcones-AdministratorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff did not assist resident with feeding
Staff do not ensure that resident's toileting needs are met
Staff do not ensure resident's room is clean
Staff do not ensure facility is free of bad odors
Staff are unable to communicate with resident due to a language barrier
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alviso arrived to conduct a complaint inspection; LPA was greeted by the caregivers that were on duty. Caregiver Liza contacted the Administrator Arthur Alcones regarding the LPA's arrival to the facility. Administrator arrived to meet with the LPA.
Reporting party alleges that staff did not assist resident with feeding, staff do not ensure that resident's toileting needs are met, staff do not ensure resident's room is clean, staff do not ensure facility is free of bad odors, and staff are unable to communicate with resident due to a language barrier. LPA reviewed resident R1's records, and obtained copies. LPA reviewed staff files. The LPA interviewed staff and other related parties. The LPA toured the facility, inspecting all common areas, bathrooms, resident rooms, facility supplies, including food supply.

The investigation revealed that per interviews and record reviews, R1 is able to feed self, and has minimal assistance at meal times; R1 is provided meal reminders and/or cueing to eat their meal, but is able to eat on their own. LPA observed R1 receiving their meal and eating on their own, including obtaining a chocolate candy on own and eating it. Per R1's medical assessment, signed by Physician, R1 can feed themselves.
Continued on LIC9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024
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-20241107111818
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: 12/09/2024
NARRATIVE
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Per investigation, interviews with staff and other parties, R1 is incontinent, resident is receiving incontinent care as needed. Staff empty R1's catheter as needed, and R1 is toileted for bowel movements as needed and able. R1 was observed to be clean, and dressed appropriately. R1 is changed and cleaned as needed. R1 has a commode to use as needed and wanted, all incontinent and toileting assistance is provided to R1 by staff, per interviews.

LPA observed the facility to be free from foul odors, including R1's room on both inspection dates of 11/14 and 12/9, 2024; R1's bedroom, and the rest of the facility, were observed to be clean and orderly during both of the inspections.

LPA observed staff and residents interacting, speaking to each other, during the inspection, including R1. Per interviews, LPA observed that the staff were able to speak English, and were able to communicate with the LPA, and with residents in care.

The investigation found that there was differing information obtained regarding allegations that were reported There was no information obtained to support that the reported violations had occurred.

Based on the interviews, record/document reviews, and related information obtained during the investigation, the allegations "staff did not assist resident with feeding, staff do not ensure that resident's toileting needs are met, staff do not ensure resident's room is clean, staff do not ensure facility is free of bad odors, and staff are unable to communicate with resident due to a language barrier" are Unsubstantiated, meaning that 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.

No deficiencies cited.
Exit interview was conducted with the Administrator, Arthur Alcones.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024
LIC9099 (FAS) - (06/04)
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