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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 125000579
Report Date: 06/13/2025
Date Signed: 06/13/2025 11:58:35 AM

Unfounded


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
06/05/2025 and conducted by Evaluator Kimberley Mota
COMPLAINT CONTROL NUMBER: 21-AS-20250605110719
FACILITY NAME:TIMBER RIDGE AT EUREKAFACILITY NUMBER:
125000579
ADMINISTRATOR:FARNUM, LARONAFACILITY TYPE:
740
ADDRESS:2740 TIMBER RIDGE LANETELEPHONE:
(707) 443-3000
CITY:EUREKASTATE: CAZIP CODE:
95503
CAPACITY:75CENSUS: DATE:
06/13/2025
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Haylee Campbell, Med TechTIME COMPLETED:
09:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility failed to arrange for medical care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Manager (LPM) Mota arrived unannounced for the purpose of initiating a complaint investigation regarding the above allegation and met with Haylee Campbell, Med Tech.

The department had left messages with the reporting party on June 5, 2025, and June 12, 2025, with no return calls. During interviews with the Administrator on June 12, 2025, it was discovered that the Resident (R1) does not reside at Timber Ridge at Eureka but does reside at Renaissance at Timber Ridge (Facility #125000592).

This agency has investigated the complaint alleging facility failed to arrange for medical care. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5070
LICENSING EVALUATOR NAME: Kimberley MotaTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2025
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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