126801366-3-21-2023-21-AS-CMAZ-CR42A6-20230420171303

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 126801366
Report Date: 03/21/2023
Date Signed: 03/21/2023 12:42:48 PM

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
02/24/2023 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20230224094913

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: 75	DATE:	03/21/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	David Uballez		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility staff not answering phones in a timely manner.

Facility did not communicate to authorized representative on the change of resident medical condition.

INVESTIGATION FINDINGS:

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At approximately 10:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an investigation into the above allegations. LPA met with Executive Director David Uballez, reviewed records and interviewed staff. LPA was informed that telephone calls after hours are either answered by the medication technician or a caregiver, if they are near the phone. If there are no staff nearby, the phone call is transferred to the manager on duty. If the manager on duty does not answer, a voicemail system is triggered and the caller can leave a message. In the event of an emergency with a resident, the facility staff will contact the responsible party after they have communicated with emergency personnel. LPA reviewed documents and interviewed staff regarding the facilities process to notify a responsible party of a residents change in condition. When a resident has a change that involves any emergency personnel, the responsible party is notified immediately. Continued on LIC9099-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: 03/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023

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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Control Number 21-AS-20230224094913

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: 03/21/2023

NARRATIVE

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If the change in condition is a medication change or other minor change, the responsible party is notified as needed. LPA was informed that some responsible parties do not want to be notified about minor items and will let the facility manage day to day changes.

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 during this visit.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher Arnhold	TELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023

LIC9099 (FAS) - (06/04)

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