126804083-8-4-2023-21-AS-BMOS-CUYU93-20230823152226

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 126804083
Report Date: 08/04/2023
Date Signed: 08/04/2023 11:24:45 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
06/26/2023 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20230626092855

FACILITY NAME:	CARING COMPANIONS CARE HOME		FACILITY NUMBER:	126804083
ADMINISTRATOR:	RASMUSSEN, COLLEN		FACILITY TYPE:	740
ADDRESS:	2641 HALL AVE		TELEPHONE:	(707) 616-5693
CITY:	EUREKA	STATE: CA	ZIP CODE:	95503
CAPACITY:	15	CENSUS: 10	DATE:	08/04/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Collen Rasmussen		TIME COMPLETED:	11:40 AM

ALLEGATION(S):

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Personal Rights - resident was sexually assaulted while in care
Personal Rights - resident was physically assaulted while in care

INVESTIGATION FINDINGS:

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At approximately 8:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to deliver the results from an investigation into the above allegations. LPA met with Administrator Collen Rasmussen. The investigation included interviews with staff, residents and a review of records. Interviews and documents showed resident was not sexually or physically assaulted at anytime while at the facility. An examination by a physician showed resident had a medical condition and medication was prescribed to address the situation. Daily staff documentation and interviews conducted showed they observed resident on multiple occasions touching themselves and using the bathroom exessivly. Resident began to complain of itchiness and soreness to their genital area. On 06/26/2023, staff observed blood in residents undergarments. Resident was taken to the hospital to address their concerns. 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: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

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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Control Number 21-AS-20230626092855

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: CARING COMPANIONS CARE HOME	FACILITY NUMBER: 126804083
	VISIT DATE: 08/04/2023

NARRATIVE

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Discharge paperwork showed resident suffered from dryness and was prescribed medication to address the issue. On 04/10/2023, resident suffered a fall, causing a laceration to their eye. Resident received stiches. Discharge paperwork instructed resident to return to the emergency room or physician to have stiches removed in approximately 5 days. Incident was reported to CCL the following day. Based on a record review and interviews conducted, there were no incidents where resident was physically handled or grabbed. Resident is on frequent checks and staff documents their behaviors daily.

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.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher Arnhold	TELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

LIC9099 (FAS) - (06/04)

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