126801366-3-4-2021-21-AS-KMOA-BZ5RT4-20210315131745

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 126801366
Report Date: 03/04/2021
Date Signed: 03/04/2021 04:27:34 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
10/30/2020 and conducted by Evaluator Christopher Arnhold

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20201030094317

FACILITY NAME:	TIMBER RIDGE AT MCKINLEYVILLE		FACILITY NUMBER:	126801366
ADMINISTRATOR:	UBALLEZ, DAVID		FACILITY TYPE:	740
ADDRESS:	1400 NURSERY WAY		TELEPHONE:	(707) 839-9100
CITY:	MCKINLEYVILLE	STATE: CA	ZIP CODE:	95519
CAPACITY:	108	CENSUS:	DATE:	03/04/2021
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Larona Farnum		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff are not seeking proper medical attention for residents in care.

Staff are mishandling resident's medications.

INVESTIGATION FINDINGS:

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At approximately 2:30PM, Licensing Program Analyst (LPA) Chris Arnhold contacted Executive Director Larona Farnum to deliver investigative findings for the above allegations. This visit is being conducted by telephone due to Covid-19 precautions. Based on a review of records and interviews conducted, an assessment is always conducted for residents that suffer an injury or state they are not feeling well. If it is determined the resident requires a higher level of care, emergency personnel are contacted and the resident is taken to the hospital for evaluation. Facility has an emergency protocol that staff are trained on for these types of incidents. LPA reviewed medication administration records and physician orders. Based on records reviewed, facility staff are following physician orders and documenting correctly.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is Unsubstantiated. No citations issued during this visit. Original signature on file.

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: 03/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2021

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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