126801366-8-4-2022-21-AS-BMOS-CJ8RZL-20220913132806

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 126801366
Report Date: 08/04/2022
Date Signed: 08/04/2022 09:46:26 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
06/30/2022 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20220630154318

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:	DATE:	08/04/2022
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	David Uballez		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Facility does not have adequate staff to meet residents needs
Personal Rights
Staff not administering medication as prescribed

INVESTIGATION FINDINGS:

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At approximately 8:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility, unannounced, to deliver findings for the allegations listed above. LPA met with Administrator David Uballez. During this investigation, LPA reviewed staffing schedules, staff training records and a sampling of resident records for the memory care section of the facility. LPA did not find any instances where a residents need was not met due to a lack of staff or training. LPA observed staff assisting residents with feeding and ambulating during the noon meal period on two occations. During this investigation, LPA spoke with several staff regarding the different care needs of residents and if they were being met. All staff interviewed were able to explain each of the residents needs and how they meet them. LPA observed the meals served to residents then reviewed resident records, regarding the physician orders and found that food was being served within physician orders. Residents that require assistance with meals were being assisted in line with physician orders. LPA spoke with staff regarding the music options during meals. Staff stated that "Pandora" is used and is set to classics and soft Jazz or Blues. Continued on LIC 9099-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: 08/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022

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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Control Number 21-AS-20220630154318

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: TIMBER RIDGE AT MCKINLEYVILLE	FACILITY NUMBER: 126801366
	VISIT DATE: 08/04/2022

NARRATIVE

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LPA observed staff offering fluids to residents often to ensure they stay hydrated. LPA reviewed medication administration logs and physician orders. LPA did not find any indication that medication was not administered as ordered. LPA reviewed unusual incident reports submitted by facility in regards to residents being sent to the emergency room, due to medications not being given as ordered and did not find any documentation that this occurred. LPA reviewed discharge paperwork and did not find any occurrence of medications being involved.

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.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher Arnhold	TELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022

LIC9099 (FAS) - (06/04)

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