210111734-2-3-2023-21-AS-HDBI-CP62E6-20230217161925

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 210111734
Report Date: 02/03/2023
Date Signed: 02/03/2023 12:04:11 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 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
12/14/2022 and conducted by Evaluator Victoria Bertozzi

COMPLAINT CONTROL NUMBER: 21-AS-20221214142506

FACILITY NAME:	WILD FLOWERS RCFE		FACILITY NUMBER:	210111734
ADMINISTRATOR:	ALLEN, C. ELIZABETH		FACILITY TYPE:	740
ADDRESS:	256 SUNSET PARKWAY		TELEPHONE:	(415) 264-7399
CITY:	NOVATO	STATE: CA	ZIP CODE:	94945
CAPACITY:	6	CENSUS: 4	DATE:	02/03/2023
		UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Caregiver, Gladys Flores		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff not following proper sanitizing practices.

INVESTIGATION FINDINGS:

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LPA Bertozzi arrived unannounced to deliver findings regarding the above compaint allegation and met with Caregiver, Gladys Flores. Licensee Elizabeth Allen was available by phone.

During investigation LPA conducted interviews, reviewed documents and made observations.

Staff not following proper sanitizing practices – Complaint alleges that a facility staff answered the door with soiled gloves from providing wound care leaving blood on the door. Per interviews, facility staff do not provide wound care to residents in care. Staff denied answering the door in soiled gloves and providing wound care to a resident in care. LPA observed doors during inspection and did not see evidence of blood on or near handles.

A finding that the complaint allegation that staff are not following proper sanitizing practices was unsubstantiated meaning that although the allegation may have happened there is not a preponderance of evidence to prove that the allegations occurred.

No deficiencies cited.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023

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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