216804000-8-21-2024-21-AS-VBEI-D8KUJ7-20240828153702

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 216804000
Report Date: 08/21/2024
Date Signed: 08/21/2024 12:10:39 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
05/14/2024 and conducted by Evaluator Caitlynn Felias

COMPLAINT CONTROL NUMBER: 21-AS-20240514163205

FACILITY NAME:	COGIR OF SAN RAFAEL		FACILITY NUMBER:	216804000
ADMINISTRATOR:	SUSAN EDWARDS		FACILITY TYPE:	740
ADDRESS:	111 MERRYDALE ROAD		TELEPHONE:	(415) 472-6530
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94903
CAPACITY:	70	CENSUS: 44	DATE:	08/21/2024
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Regional Executive Director, Davina Barker		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff is not following doctor's orders for resident's wound care
Staff is overcharging resident in care

INVESTIGATION FINDINGS:

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At approximately 11:30AM, Licensing Program Analyst (LPA) Felias arrived unannounced to deliver findings for this Complaint Investigation regarding the above allegations and met with Regional Executive Director, Davina Barker.

During the course of the investigation, the Department requested and reviewed documents, conducted interviews, and made observations. There is an allegation that “Staff is overcharging resident in care.” Complainant stated that Facility billed Resident 1 (R1) for a compression sleeve that R1 does not use or need. Complainant also alleged that the facility refused entry to the home health agency that was ordered to provide wound care and instead provided the wound care in the facility costing more money and more levels of care for the resident. Review of facility documents show that R1’s Physician ordered for them to have a compression leg machine and compression stockings dated 06/03/2021 and 05/17/2023.

Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Caitlynn Felias	TELEPHONE: 707-588-5039
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024

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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Control Number 21-AS-20240514163205

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: COGIR OF SAN RAFAEL	FACILITY NUMBER: 216804000
	VISIT DATE: 08/21/2024

NARRATIVE

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Continued from LIC9099

Facility received discontinue orders for R1’s compression devices on 05/06/2024 and 05/08/2024. Per document review, Facility stopped providing service for the compression socks once the doctor discontinued their use. During the investigation, Complainant also stated that R1 received orders for wound care to be done by Home Health and that R1 and their Responsible Party were being charged for the service. This concern was substantiated on 08/08/2024 in Complaint Investigation: 21-AS-20240424094747. Per discussion with Regional Executive Director, these charges since have been removed from R1’s bill. This allegation is Unsubstantiated.

There is an allegation that “Staff is not following doctor’s orders for resident’s wound care.” Complainant stated that wound care was ordered for the resident for wound care to be provided at Cogir by a home health agency. Complaint alleged that facility was not allowing home health in the building and instead provided the wound care themselves. Again, this concern was substantiated on 08/08/2024 in Complaint Investigation: 21-AS-20240424094747. Per discussion with Regional Executive Director, these charges since have been removed from R1’s bill. Per investigation, facility did not deny entry to the home health agency. This allegation is Unsubstantiated.

A finding that the complaint allegation is Unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

No Deficiencies Cited during visit.

Exit interview conducted. Copy of report and Confidential Names (LIC811) discussed and provided to Regional Executive Director. Signature on form confirms receipt of documents.

SUPERVISOR'S NAME: Victoria Bertozzi	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Caitlynn Felias	TELEPHONE: 707-588-5039
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024

LIC9099 (FAS) - (06/04)

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