126803830-12-14-2020-21-AS-BMOS-BWYP38-20210105095707

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 126803830
Report Date: 12/14/2020
Date Signed: 12/14/2020 01:29:11 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
12/03/2020 and conducted by Evaluator Christopher Arnhold

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20201203132526

FACILITY NAME:	SEQUOIA SPRINGS SENIOR LIVING COMMUNITY		FACILITY NUMBER:	126803830
ADMINISTRATOR:	ENDERT, ROGER		FACILITY TYPE:	740
ADDRESS:	2401 REDWOOD WAY		TELEPHONE:	(541) 840-4035
CITY:	FORTUNA	STATE: CA	ZIP CODE:	95540
CAPACITY:	92	CENSUS:	DATE:	12/14/2020
		UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Gina Frost		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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9

Facility is refusing to take back residents from the hospital.

INVESTIGATION FINDINGS:

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At approximately 11:20AM, Licensing Program Analyst (LPA) Chris Arnhold contacted Executive Director Jeanna Frost to conduct a complaint investigation into the above allegation. This visit is being conducted via telephone due to Covid-19 precautions. Interviews conducted described that the facility, in the past, has been hesitant to accept residents back from the hospital unless they were at baseline. Based on interviews conducted with facility staff, this is no longer the case. As long as a resident meets the requirements of regulation, the facility accepts residents back from the hospital.
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 during this visit.
Original Signature on file.

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: 12/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2020

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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