126803830-8-10-2020-21-AS-BMOS-BSEQUX-20200812122928

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 126803830
Report Date: 08/10/2020
Date Signed: 08/10/2020 04:00:38 PM

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
05/27/2020 and conducted by Evaluator Christopher Arnhold

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20200527152251

FACILITY NAME:	SEQUOIA SPRINGS SENIOR LIVING COMMUNITY		FACILITY NUMBER:	126803830
ADMINISTRATOR:	ENDERT, ROGER		FACILITY TYPE:	740
ADDRESS:	2401 REDWOOD WAY		TELEPHONE:	(801) 325-0124
CITY:	FORTUNA	STATE: CA	ZIP CODE:	95540
CAPACITY:	92	CENSUS:	DATE:	08/10/2020
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Roger Endert		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Unlawful Eviction

INVESTIGATION FINDINGS:

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At approximately 11:45AM, Licensing Program Analyst (LPA) Chris Arnhold contacted Executive Director Roger Endert via telephone to deliver investigative findings for the above allegation. This visit is being conducted via telephone due to Covid-19 precautions. On 06/05/2020, LPA interviewed staff regarding the situation. R1 was sent to the emergency room due to a high temperature and general decline in addition to facility not having the proper hospital bed for R1 to use. The current bed was queen sized and staff were forced to climb onto the bed to assist R1. This posed a risk for both staff and resident. The hospital wanted to discharge resident back to facility but facility refused to accept R1 back until a hospital bed could be delivered. Due to Covid-19, there was a shortage of hospital beds and Hospice was not able to provide the necessary equipment for the facility to provide for the needs of R1. Facility did not issue an eviction and would have accepted R1 back if they had received the proper equipment. Report continued on LIC 9099-C...

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: 08/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2020

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-20200527152251

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: SEQUOIA SPRINGS SENIOR LIVING COMMUNITY	FACILITY NUMBER: 126803830
	VISIT DATE: 08/10/2020

NARRATIVE

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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.

No citations issued in relation to this complaint.

This report was reviewed with Executive Director Roger Endert and sent via email for signature.

Original signature on file.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher Arnhold	TELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2020

LIC9099 (FAS) - (06/04)

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