126803419-8-19-2021-21-AS-BMOS-C6NT56-20210908142501

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 126803419
Report Date: 08/19/2021
Date Signed: 08/19/2021 09:43:17 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/20/2021 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20210520084610

FACILITY NAME:	KLLG, CORPORATION - REDWOOD R AND R		FACILITY NUMBER:	126803419
ADMINISTRATOR:	LEAH HANRAHAN-GEE		FACILITY TYPE:	740
ADDRESS:	3231 DOLBEER		TELEPHONE:	(707) 268-8699
CITY:	EUREKA	STATE: CA	ZIP CODE:	95503
CAPACITY:	14	CENSUS: 7	DATE:	08/19/2021
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Leah Gee		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Facility staff neglected to observe resident change of condition

INVESTIGATION FINDINGS:

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At approximately 8:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived to this facility, unannounced, to deliver findings from an investigation conducted into the above allegation. LPA met with Administrator Leah Gee. The resident came to this facility from a rehabilitation facility that did not remove an IV port during the discharge. Facility staff noticed the port while conducting a body check upon admission to the facility. Administrator contacted the rehabilitation facility to have the port removed. The facility told Administrator that they could not because the resident was no longer theirs. Administrator contacted the emergency department who also refused to remove the port. Administrator contacted residents physician to have the port removed and an appointment was made. The soonest appointment was in 5 days. The following day, resident fell and required a trip to the emergency room. Resident did not return to the facility. Resident was only at facility for a few days. 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: 08/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

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-20210520084610

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: KLLG, CORPORATION - REDWOOD R AND R	FACILITY NUMBER: 126803419
	VISIT DATE: 08/19/2021

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is 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: 08/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

LIC9099 (FAS) - (06/04)

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