286803264-2-24-2022-21-AS-BMOS-CCZM5P-20220330091838

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 286803264
Report Date: 02/24/2022
Date Signed: 02/24/2022 12:37:46 PM

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
01/13/2022 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20220113084102

FACILITY NAME:	NAZARETH ROSE GARDEN OF NAPA		FACILITY NUMBER:	286803264
ADMINISTRATOR:	GOCO, MARISOL		FACILITY TYPE:	740
ADDRESS:	903 SARATOGA DRIVE		TELEPHONE:	(707) 252-7488
CITY:	NAPA	STATE: CA	ZIP CODE:	94559
CAPACITY:	44	CENSUS: 30	DATE:	02/24/2022
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Minerva Villegas		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Resident is not being allowed to have a comfortable bed while in care.

INVESTIGATION FINDINGS:

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At approximately 11:15AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct an investigation into the above allegation. LPA met with Minerva Villegas, interviewed resident and toured the facility. Based on interviews conducted during this investigation, Resident had a personal mattress on their bed. R1 was diagnosed with Covid-19 and was required to quarantine. R1 and their mattress were moved to a separate wing of the facility, as per their Mitigation plan, to lessen the spread. Mattresses in the facility were inspected and found to meet regulation. The mattresses are in good condition and are clean. When resident came out of quarantine, they moved back into their room along with their mattress.
This agency has investigated the above allegation. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. No citations issued.

Unfounded

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: 02/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2022

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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