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Department of
SOCIAL SERVICES

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 MCKINLEYVILLEFACILITY NUMBER:
126801366
ADMINISTRATOR:FARNUM, LARONAFACILITY TYPE:
740
ADDRESS:1400 NURSERY WAYTELEPHONE:
(707) 839-9100
CITY:MCKINLEYVILLESTATE: CAZIP CODE:
95519
CAPACITY:108CENSUS: 72DATE:
05/26/2022
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Larona FarnumTIME COMPLETED:
08:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained unexplained injury
Facility did not report resident injury
Facility staff handled resident roughly
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
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 MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher ArnholdTELEPHONE: (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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