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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 126803939
Report Date: 10/31/2023
Date Signed: 10/31/2023 08:26:12 AM

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
08/04/2023 and conducted by Evaluator Christopher Arnhold
COMPLAINT CONTROL NUMBER: 21-AS-20230804105626
FACILITY NAME:ESPECIALLY YOU ASSISTED LIVING, INC.FACILITY NUMBER:
126803939
ADMINISTRATOR:MITCHELL, AMANDA L.FACILITY TYPE:
740
ADDRESS:12 HENDERSON STREETTELEPHONE:
(707) 443-8838
CITY:EUREKASTATE: CAZIP CODE:
95501
CAPACITY:15CENSUS: DATE:
10/31/2023
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Jessie RegnierTIME COMPLETED:
08:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are verbally abusing residents and physically intimidating them
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At approximately 8:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to deliver findings from an investigation into the above allegation. LPA met with Jessie Regnier. Based on interviews conducted and documents reviewed, there was no evidence that staff verbally abused or intimidated resident. On the contrary, based on records reviewed and interviews conducted, R1 was verbally abusive to staff and when asked to stop, would accuse staff of being assaultive. R1 would threaten to hit staff if they did not do what was asked.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher ArnholdTELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023
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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