126803254-2-3-2022-21-AS-BMOS-CCBVYM-20220308155122

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 126803254
Report Date: 02/03/2022
Date Signed: 02/03/2022 03:36:14 PM

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
01/26/2022 and conducted by Evaluator Christopher Arnhold

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20220126121641

FACILITY NAME:	ADDIE MEEDOM HOUSE		FACILITY NUMBER:	126803254
ADMINISTRATOR:	COLLINS, JENNIFER		FACILITY TYPE:	740
ADDRESS:	1445 PARKWAY DRIVE		TELEPHONE:	(707) 464-3311
CITY:	CRESCENT CITY	STATE: CA	ZIP CODE:	95531
CAPACITY:	63	CENSUS: 36	DATE:	02/03/2022
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Allison Fitch		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility in disrepair

Uncleared staff

INVESTIGATION FINDINGS:

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At approximately 10:45AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility to conduct an investigation into the above allegations. LPA met with Administrator Allison Fitch and toured the facility. The facility was clean and at a comfortable temperature. LPA observed there was a repair in process on one of the hallway ceilings to repair a water leak. Screens were observed to be on most windows, however, the facility currently has a resident that is knocking screens out of the windows. LPA observed the screens on the ground in front of the windows. The fire alarm system recently had an issue but it was addressed by an outside contractor. LPA was informed that a helper was brought in to assist the maintanance person to paint some rooms. The helper was then offered a position to work at the facility. They were not assisting residents and was supervised by the maintance person at all times. 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.

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: 02/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022

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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