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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 286803573
Report Date: 09/03/2024
Date Signed: 09/03/2024 11:14:33 AM

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
05/21/2024 and conducted by Evaluator Julie Florio
COMPLAINT CONTROL NUMBER: 21-AS-20240521143208
FACILITY NAME:E.R.SALGADO,INC./SAINT LUCIA RESIDENTIAL CAREFACILITY NUMBER:
286803573
ADMINISTRATOR:ROSE SALGADOFACILITY TYPE:
735
ADDRESS:134 LANDANA STREETTELEPHONE:
(707) 315-4838
CITY:AMERICAN CANYONSTATE: CAZIP CODE:
94503
CAPACITY:6CENSUS: DATE:
09/03/2024
ANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Rose Salgado, Administrator/LicenseeTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Facility staff failed to seek timely medical attention
INVESTIGATION FINDINGS:
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On 9/3/2024, Licensing Program Analyst (LPA) Julie Florio arrived to the previously scheduled, in-office, informal meeting and met with Licensee, Rose Salgado, to deliver findings of above allegation. Reporting Party (RP) alleges on 5/20/2024 client (C1) was observed to have facial bruise and alleges medical attention was not sought timely. LPA conducted 10-day on 5/24/2024 and obtained documents, made observations, took photos, and conducted interviews with staff (S1), Licensee, and Client (C1). Based on LPAs interviews LPA received conflicting information on the date C1 sustained the facial bruise. On 8/16/2024 LPA received documentation from Licensee to confirm that upon notification, on 5/20/2024, from outside party regarding the injury observed, C1 was taken to their Primary Care Physician (PCP) the same day for evaluation and was referred for a CT brain scan which was completed on 6/3/2024. The results of said scan were unremarkable according to the doctor’s final report.

Continued on LIC9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 21-AS-20240521143208
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: E.R.SALGADO,INC./SAINT LUCIA RESIDENTIAL CARE
FACILITY NUMBER: 286803573
VISIT DATE: 09/03/2024
NARRATIVE
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Based on record review, interviews conducted, and observations made, the allegation of Facility failed to seek timely medical attention is Unsubstantiated. A finding that the complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

No Deficiencies cited during visit.

Exit interview conducted. Copy of report discussed and provided to Licensee. Signature on form confirms receipt of documents.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024
LIC9099 (FAS) - (06/04)
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