121372020-1-6-2025-21-AS-KMOA-DFTQZZ-20250417123733

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 121372020
Report Date: 01/06/2025
Date Signed: 01/06/2025 02:13:25 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
12/30/2024 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20241230150731

FACILITY NAME:	FRYE'S CARE HOME		FACILITY NUMBER:	121372020
ADMINISTRATOR:	DELORES FRYE		FACILITY TYPE:	740
ADDRESS:	2240 FERN STREET		TELEPHONE:	(707) 442-2712
CITY:	EUREKA	STATE: CA	ZIP CODE:	95503
CAPACITY:	58	CENSUS: 36	DATE:	01/06/2025
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Katelyn Formby		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff did not prevent inappropriate touching between residents

INVESTIGATION FINDINGS:

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At approximately 11:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an inspection into the above allegation. LPA met with facility mananger Katelyn Formby, reviewed records and interviewed staff. Based on interviews conducted and records reviewed, residents are free to walk around the facility and interact with each other as they wish. Staff are aware of the interactions between the two residents and have not observed any behaviors that are dangerous. Neither resident is conserved. Facility has met with both responsible parties and reviewed the personal rights of residents living in assisted living. LPA received copies of documents.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher Arnhold	TELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2025

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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