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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 126803830
Report Date: 12/23/2024
Date Signed: 12/23/2024 02:25:26 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
12/17/2024 and conducted by Evaluator Christopher Arnhold
COMPLAINT CONTROL NUMBER: 21-AS-20241217090243
FACILITY NAME:SEQUOIA SPRINGS SENIOR LIVING COMMUNITYFACILITY NUMBER:
126803830
ADMINISTRATOR:ROGER ENDERTFACILITY TYPE:
740
ADDRESS:2401 REDWOOD WAYTELEPHONE:
(541) 840-4035
CITY:FORTUNASTATE: CAZIP CODE:
95540
CAPACITY:92CENSUS: 81DATE:
12/23/2024
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Roger EndertTIME COMPLETED:
02:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff made an inappropriate comment regarding a resident
Staff mishandled the residents pendants
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At approximately 11:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to open an investigation into the above allegations. LPA met with Executive Director Roger Endert, reviewed records and interviewed staff. Based on interviews conducted, LPA was not able to find evidence to support the allegation that staff made an inappropriate comment regarding a resident. LPA reviewed records regarding resident care and observed a recent meeting discussing an agreed upon risk assessment based on resident care needs. LPA interviewed individuals that attended the meeting and was not able to find evidence that staff made inappropriate comments. LPA reviewed records and interviewed staff regarding resident pendant procedures. LPA was informed that a staff had removed a pendant from a resident. The staff member was preparing resident for bathing and removed the pendant and placed it on a counter. After assisting the resident, staff forgot to return the pendant to resident. Resident was without their pendant for approximately 4 hours, until staff was alerted to the situation. There were no issues in this timeframe. LPA reviewed the previous 90 days of pendant logs and observed resident had access to their pendant. 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.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024
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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