126803254-9-11-2023-21-AS-BMOS-CWXT6C-20231025142654

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 126803254
Report Date: 09/11/2023
Date Signed: 09/11/2023 02:22:51 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
08/14/2023 and conducted by Evaluator Christopher Arnhold

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20230814122112

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: 31	DATE:	09/11/2023
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Allison Fitch		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Facility does not meet resident care needs
Staff are not trained to meet the needs of resident's in care
Staff did not seek medical attention for residents in a timely manner
Staff do not keep the facility free from pet feces

INVESTIGATION FINDINGS:

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At approximately 12:30PM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an investigation into the above allegations. LPA met with Executive Director Allison Fitch, reviewed records and toured the building. During the course of this investigation, LPA reviewed resident care plans and staff training records. LPA observed that all care staff initial resident service plans, affirming they have read and understand the needs of each resident. When a service plan is updated, staff again affirm they have read and understand by initialing the updated plan. LPA reviewed the training program of the facility. The facility utilizes Relias Training system to track initial and ongoing training. A new staff shadows a fully trained staff for several days to observe and demonstrate what they have learned. They receive a sign off from that staff when they have successfully demonstrated the task. Continued on LIC 9099-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: 09/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2023

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-20230814122112

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: 09/11/2023

NARRATIVE

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Based on records reviewed and interviews conducted, LPA was not able to find any residents that did not have their medical needs addressed. LPA reviewed documentation from staff that shows prompt attention to any medical need a resident may express. LPA observed facility notifies the physician of resident complaints and ensures emergency personnel are summoned when needed. The facility then reports the incident as regulation requires. During the course of this investigation, LPA toured the building and grounds. LPA did not observe any pet feces unattended. Based on interviews conducted, several residents either have pets or have family visit with pets. LPA learned from staff that they have not observed pet feces that was not in a litter box or on the floors in the facility. LPA was informed that the residents that have pets, either take care of them themselves or have family that addresses the pets needs.

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: 09/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

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
08/14/2023 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20230814122112

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: 31	DATE:	09/11/2023
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Allison Fitch		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Staff did not provide a bed for resident

INVESTIGATION FINDINGS:

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At approximately 12:30PM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an investigation into the above allegations. LPA met with Executive Director Allison Fitch, reviewed records and toured the building. During the course of this investigation, LPA reviewed resident care plans and physician orders. LPA observed a resident did not have a bed in the room and resident was in a recliner. LPA reviewed physician orders and found the physician has ordered the resident to use a reclining chair instead of bed, due to it being more comfortable. LPA verified with facility that a bed is available for the residents use if they wish.
This agency has investigated the above allegation. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Unfounded

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: 09/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2023

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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