125000592-9-30-2020-21-AS-BMOS-BV8QXP-20201110113350

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 125000592
Report Date: 09/25/2020
Date Signed: 09/30/2020 03:46:58 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/27/2020 and conducted by Evaluator Christopher Arnhold

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20200727111512

FACILITY NAME:	RENAISSANCE AT TIMBER RIDGE		FACILITY NUMBER:	125000592
ADMINISTRATOR:	FARNUM, ERICA		FACILITY TYPE:	740
ADDRESS:	2780 TIMBER RIDGE LANE		TELEPHONE:	(707) 443-3000
CITY:	EUREKA	STATE: CA	ZIP CODE:	95503
CAPACITY:	22	CENSUS:	DATE:	09/25/2020
		UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Erica Farnum		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Resident in care was sexually abused
Facility staff do not keep the facility clean
Facility is in disrepair, hole in ceiling
Facility staff handled residents in a rough manner
Facility staff are not properly trained

INVESTIGATION FINDINGS:

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At approximately 4:00 PM, Licensing Program Analyst (LPA) Chris Arnhold conducted an unannounced virtual visit with Administrator Erica Farnum to complete this complaint investigation. LPA virtually toured the facility. Interviews were conducted with staff currently working on the floor. LPA was not able to determine if a resident was sexually abused at the facility. Staff were unaware of any such incidents and no residents have brought it up to them. Facility was clean and orderly during the visual inspection. LPA requested Erica to comment on the smell as she was walking to various parts of the facility and claimed there was no foul smells. Erica showed LPA where there was a hole in the ceiling. The facility had a water leak which caused the ceiling issue. The repair company was contacted immediately and the issue was resolved. Erica stated there was an incident with a resident where she had to take away a molding piece of meat. The resident did not understand the risk of eating the piece of food and did not like.... 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: 09/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2020

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-20200727111512

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: RENAISSANCE AT TIMBER RIDGE	FACILITY NUMBER: 125000592
	VISIT DATE: 09/25/2020

NARRATIVE

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Like the administrator taking the item and tried to hold onto it. The resident was not injured in this incident. LPA requested training documentation for staff working at this facility. All staff records showed the required training being completed.
The information provided by the complainant for this complaint did not specify dates, times or resident information. Interviews conducted with staff did not reveal any violations of regulation pertaining to these allegations.

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.

Report reviewed with Administrator.

Original signature on file.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher Arnhold	TELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2020

LIC9099 (FAS) - (06/04)

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