126801366-1-31-2023-21-AS-BMOS-CPHRYK-20230301122627

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 126801366
Report Date: 01/31/2023
Date Signed: 01/31/2023 09:28:41 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
01/06/2023 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20230106105633

FACILITY NAME:	TIMBER RIDGE AT MCKINLEYVILLE		FACILITY NUMBER:	126801366
ADMINISTRATOR:	DAVID UBALLEZ		FACILITY TYPE:	740
ADDRESS:	1400 NURSERY WAY		TELEPHONE:	(707) 839-9100
CITY:	MCKINLEYVILLE	STATE: CA	ZIP CODE:	95519
CAPACITY:	108	CENSUS: 76	DATE:	01/31/2023
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	David Uballez		TIME COMPLETED:	09:45 AM

ALLEGATION(S):

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Facility is not following appropriate covid protocols

INVESTIGATION FINDINGS:

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At approximately 8:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct an investigation into the above allegation. LPA met with Executive Director David Uballez, interviewed staff and reviewed documents. Based on interviews conducted, staff are instructed to stay home if they feel ill. If a staff calls out due to illness, there were no supporting interviews to indicate the supervisor asks them to come to work. LPA interviewed all staff working at the time of this visit and none provided information to support the allegation.

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 allegation is 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: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

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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