126801366-5-26-2022-21-AS-BMOS-CF7NJW-20220608103101

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 126801366
Report Date: 05/26/2022
Date Signed: 05/26/2022 11:13:20 AM

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
04/05/2022 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20220405124405

FACILITY NAME:	TIMBER RIDGE AT MCKINLEYVILLE		FACILITY NUMBER:	126801366
ADMINISTRATOR:	FARNUM, LARONA		FACILITY TYPE:	740
ADDRESS:	1400 NURSERY WAY		TELEPHONE:	(707) 839-9100
CITY:	MCKINLEYVILLE	STATE: CA	ZIP CODE:	95519
CAPACITY:	108	CENSUS: 72	DATE:	05/26/2022
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Larona Farnum		TIME COMPLETED:	08:45 AM

ALLEGATION(S):

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Resident sustained unexplained injury
Facility did not report resident injury
Facility staff handled resident roughly

INVESTIGATION FINDINGS:

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At approximately 08:15AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility uannounced, to deliver findings from an investigation conducted into the above allegations. LPA met with Administrator Larona Farnum. Based on interviews conducted and records reviewed, the injury alleged to be unexplained was due to a fall that was witnessed by staff. Facility submitted an unusual incident report to CCL as required, explaining that a resident had a fall while staff was assisting resident and emergency personnel were contacted. Resident was treated at the hospital and returned to the facility. Based on interviews conducted, there was no supporting statements or documentation that facility staff handled any resident roughly.
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

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: 05/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022

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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