126801871-11-18-2024-21-AS-BMOS-DCNRGQ-20250106120108

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 126801871
Report Date: 11/18/2024
Date Signed: 11/18/2024 02:33:30 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
10/11/2024 and conducted by Evaluator Christopher Arnhold

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20241011132703

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: 22	DATE:	11/18/2024
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Sara Anderson		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff do not ensure facility/resident's restrooms are clean and sanitized.

INVESTIGATION FINDINGS:

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At approximately 11:45AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an investigation into the above allegation. LPA met with Executive Director Sara Anderson, interviewed staff and residents. Based on interviews conducted, facility housekeeper unexpectedly quit on 10/02/2024. Facility was without housekeeping services for approximately 3 weeks. During this time, housekeeping was conducted by caregivers as they found time. Based on interviews conducted, when a staff was informed of a cleaning need, they responded immediately. LPA was informed a housekeeper has been hired and cleaning is back on schedule. During the course of this investigtion, LPA observed facility bathrooms and common areas were clean and in good repair.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

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: 11/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024

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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