126801871-4-10-2023-21-AS-CMAZ-CR425G-20230420170530

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 126801871
Report Date: 04/10/2023
Date Signed: 04/10/2023 02:29:27 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
03/24/2023 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20230324084346

FACILITY NAME:	ALDER BAY ASSISTED LIVING		FACILITY NUMBER:	126801871
ADMINISTRATOR:	ANDERSON, SARA		FACILITY TYPE:	740
ADDRESS:	1355 MYRTLE		TELEPHONE:	(707) 444-8000
CITY:	EUREKA	STATE: CA	ZIP CODE:	95501
CAPACITY:	49	CENSUS: 29	DATE:	04/10/2023
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Sara Anderson		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Facility has inadequate staffing to meet resident's needs.
Staff does not answer facility phone.
Staff does not ensure resident's laundry needs are being met.
Staff does not provide activities for resident's in care.

INVESTIGATION FINDINGS:

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At approximately 11:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an investigation into the allegations listed above. LPA met with Executive Director Sara Anderson, interviewed residents and reviewed records. LPA was not able to find supporting evidence that the needs of the residents are not being met due to inadequate staffing. LPA reviewed staffing schedules and found facility had staff scheduled to meet the residents needs. LPA reviewed "resident call for assistance logs" and found the average response time for staff to respond was 7 minutes. The facility has a business office manager that answers the telephone during business hours. If a person were to call after hours or on weekends, the calls are answered by the medication technician, if available, or the call will go to voicemail. The business office manager checks for messages when they return to the office the next business day. LPA reviewed the facility laundry schedule and referenced the schedule with the staff laundry log. 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: 04/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023

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-20230324084346

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: ALDER BAY ASSISTED LIVING	FACILITY NUMBER: 126801871
	VISIT DATE: 04/10/2023

NARRATIVE

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The staff laundry log shows what room was scheduled and whether it was completed or not. The logs show that laundry is completed the majority of the time. When laundry is not completed, the caregiver writes a reason on the log. Many of the days when laundry is not completed it is due to the resident not having enough soiled clothing for a load. LPA learned there have been a couple minor laundry mishaps in the past, where a residents article of clothing was damaged or lost. The facility has worked individually with each resident to find a solution. LPA interviewed the facility Activities Director and learned there are activities offered Monday through Friday. LPA received copies of the Activities calendar for March and April which showed planned activities all throughout the day. On 03/29/2023, LPA spoke with the Resident Council about their ability to provide input on the activities provided by the facility. LPA was informed the Activities Director is very attentive to their suggestions.
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.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher Arnhold	TELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023

LIC9099 (FAS) - (06/04)

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