126803254-2-17-2023-21-AS-BMOS-CPHRPK-20230301121205

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 126803254
Report Date: 02/17/2023
Date Signed: 02/17/2023 12:28:46 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
02/13/2023 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20230213082308

FACILITY NAME:	ADDIE MEEDOM HOUSE		FACILITY NUMBER:	126803254
ADMINISTRATOR:	ALLISON FITCH		FACILITY TYPE:	740
ADDRESS:	1445 PARKWAY DRIVE		TELEPHONE:	(707) 464-3311
CITY:	CRESCENT CITY	STATE: CA	ZIP CODE:	95531
CAPACITY:	63	CENSUS: 34	DATE:	02/17/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Allison Fitch		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff do not ensure resident laundry services are done in a timely manner

Staff left residents in soiled diapers for an extended period of time

Staff do not provide residents with daily activities.

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 Administrator Allison Fitch, reviewed records and interviewed staff. Staff interviewed told LPA their duties include doing resident laundry. Facility has a laundry schedule that coorisponds with the housekeeping schedule to have laundry done. Housekeeper brings the the dirty laundry to the laundry room and all staff are responsible to ensure it is washed and folded. Once the laundry is ready to return to the room, the assigned staff for that hallway brings the laundry to room and puts it away. Staff told LPA that if laundry is not being done, it is because the staff for that laundry day didn't do their job. Facility activities Director reduced their hours in December and facility is working on filling the position. Activities are still being conducted on a daily basis. LPA was not able to find any supporting evidence to show a resident was left in soiled garments for an extended period of time. 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: 02/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023

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-20230213082308

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: ADDIE MEEDOM HOUSE	FACILITY NUMBER: 126803254
	VISIT DATE: 02/17/2023

NARRATIVE

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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.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher Arnhold	TELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023

LIC9099 (FAS) - (06/04)

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