125000592-8-3-2023-21-AS-BMOS-CWNNT2-20231016104401

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 125000592
Report Date: 08/03/2023
Date Signed: 08/03/2023 05:21:22 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
07/12/2023 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20230712112128

FACILITY NAME:	RENAISSANCE AT TIMBER RIDGE		FACILITY NUMBER:	125000592
ADMINISTRATOR:	FARNUM, LARONA		FACILITY TYPE:	740
ADDRESS:	2780 TIMBER RIDGE LANE		TELEPHONE:	(707) 443-3000
CITY:	EUREKA	STATE: CA	ZIP CODE:	95503
CAPACITY:	22	CENSUS:	DATE:	08/03/2023
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Larona Farnum		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Administration did not prevent staff from physically abusing resident in care.
Staff are not properly trained to administer resident's medications.
Staff are not keeping record of resident's medication log.
Staff leave resident's soiled for an extended period of time.

INVESTIGATION FINDINGS:

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At approximately 2:45PM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to deliver results from an investigaiton into the above allegations. LPA met with Executive Director Larona Farnum, toured the building and reviewed records. LPA reviewed incident reports from 2022 and 2023 and found no incidents of staff abusing residents or causing harm. LPA reviewed medication technician training records and found all medication technicians have the required training. LPA reviewed medication administration records for memory care and observed all medications were accounted for. LPA interviewed staff on medication practices and staff displayed a good knowledge of facility procedures. LPA received copies of training records. The building was toured on 07/20/2023 and during this visit. 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: 08/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

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-20230712112128

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: RENAISSANCE AT TIMBER RIDGE	FACILITY NUMBER: 125000592
	VISIT DATE: 08/03/2023

NARRATIVE

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There were no foul odors present during either visit. LPA interviewed staff regarding the frequency residents are assisted with incontinent products. Staff informed LPA that residents are checked frequently and are changed as needed. Spills are cleaned immediately and soiled laundry is placed in sealed containers and removed from the area.
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.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher Arnhold	TELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

LIC9099 (FAS) - (06/04)

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