125000579-8-25-2022-21-AS-BMOS-CHZU87-20220906152104

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 125000579
Report Date: 08/25/2022
Date Signed: 08/25/2022 01:18:42 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
08/16/2022 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20220816104648

FACILITY NAME:	TIMBER RIDGE AT EUREKA		FACILITY NUMBER:	125000579
ADMINISTRATOR:	FARNUM, LARONA		FACILITY TYPE:	740
ADDRESS:	2740 TIMBER RIDGE LANE		TELEPHONE:	(707) 443-3000
CITY:	EUREKA	STATE: CA	ZIP CODE:	95503
CAPACITY:	75	CENSUS: 49	DATE:	08/25/2022
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Elizabeth Christenson		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Personal Rights
Licensee is not providing medical information to resident’s authorized representative
Unlawful Eviction

INVESTIGATION FINDINGS:

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At approximately 8:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility, unannounced, to conduct an investigation into the above allegations. LPA met with Elizabeth Christenson, toured the facility, interviewed staff and reviewed records. Based on a review of records and interviews conducted, the personal rights of residents were not violated by facility staff. LPA learned there was a longstanding tension between 2 residents that lived next door to one another. Resident 1, R1, believed Resident 2, R2, was harassing them. The facility offered several different room options but resident refused to move. There were no instances between R1 and R2 that violated the facility policies so the facility could not do much about the situation. Based on interviews conducted, the facility did not receive authorization from R1 to release information. There were no documents in facility file to support the claim that the requesting individual was the authorized representative and the request was not made in writing. Continued on LIC9099-C...

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: 08/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2022

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-20220816104648

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: TIMBER RIDGE AT EUREKA	FACILITY NUMBER: 125000579
	VISIT DATE: 08/25/2022

NARRATIVE

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Based on interviews conducted, the facility did not issue an eviction notice to R1. The facility had several discussions with the hospital discharge planner regarding the care requirements of R1. The facility did not tell the resident they could not return to the facility.

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, therefore the allegations are Unsubstantiated.

No citations issued.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher Arnhold	TELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2022

LIC9099 (FAS) - (06/04)

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