176803831-6-1-2023-21-AS-HDBI-CSMQ3K-20230609114852

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 176803831
Report Date: 06/01/2023
Date Signed: 06/01/2023 09:41:02 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
02/14/2023 and conducted by Evaluator Shannan Hansen

COMPLAINT CONTROL NUMBER: 21-AS-20230214104332

FACILITY NAME:	ORCHARD PARK SENIOR LIVING COMMUNITY		FACILITY NUMBER:	176803831
ADMINISTRATOR:	AUDREANNA VERLING		FACILITY TYPE:	740
ADDRESS:	14789 BURNS VALLEY ROAD		TELEPHONE:	(707) 995-1900
CITY:	CLEARLAKE	STATE: CA	ZIP CODE:	95422
CAPACITY:	56	CENSUS: 44	DATE:	06/01/2023
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Measha Edwards, Assistant Administrator		TIME COMPLETED:	09:50 AM

ALLEGATION(S):

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Facility is not meeting the residents care needs
Staff do not respond timely to resident’s call for assistance
Facility does not have a call system in place

INVESTIGATION FINDINGS:

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At approximately 9:10 AM, Licensing Program Analyst (LPA) Hansen arrived unannounced to deliver findings regarding the above complaint allegation and met with Assistant Administrator, Measha Edwards, Administrator Audrenna Verling was not available.

During investigation, LPA reviewed documents, made observation’s and conducted interviews.

Facility does not have a call system in place & Staff do not respond timely to resident’s call for assistance – Complaint alleges facility does not have call buttons or equivalent in certain areas of the facility (Memory Care). LPA conducted interviews with Residential Coordinator, Memory Care Coordinator, and Administrator on separate occasions stating the facility has pull cords in all bathrooms, in the Assisted Living section residents have wrist call buttons which facility has a 10-minute response time according to call log report. In the memory care section, there is no wrist call button but if residents are not in the common area there is a mandatory 15-minute check.
Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Shannan Hansen	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

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-20230214104332

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: ORCHARD PARK SENIOR LIVING COMMUNITY	FACILITY NUMBER: 176803831
	VISIT DATE: 06/01/2023

NARRATIVE

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Fall risk residents in memory care have bed and or chair motion alarms also in their rooms so if a resident was to fall or move one of these, an alarm will go off in the common area alerting staff. There is no call log report on file for the motion alarms. During LPA’s visits on 2/23/2023, 3/27/2023, & 5/1/2023, 15-minute checks and alarms were observed being conducted. Complaint also alleges “Staff do not respond timely to resident’s call for assistance”. Review of call button logs showed that most calls were answered in 10 minutes or under with the exception of a smaller amount being responded to in 15 minutes. Per conversation with Administrator, AudreAnna, call bells are to be answered within 10 minutes ideally.

Facility is not meeting the residents care needs - According with observations conducted on 2/23/2023, 3/27/2023, & 5/1/2023 during LPA’s visits, residents were found to have their needs met. LPA observed R1 appear to be clean, well groomed, and up moving about the facility engaging with staff. On LPA’s last visit it was observed R1 to have freshly painted fingernails. Bedrooms were clean and in good condition, no odors, residents looked clean and well groomed, and bathrooms contained soap . Based on staffing schedule obtained, the facility appears to have sufficient staffing to meet residents care needs. Based on observations and records reviewed, LPA is unable to prove or disprove that residents’ needs were not being met.

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) 588-5026
LICENSING EVALUATOR NAME: Shannan Hansen	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

LIC9099 (FAS) - (06/04)

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