486801578-8-30-2022-21-AS-KMOA-CJAM24-20220915091255

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486801578
Report Date: 08/25/2022
Date Signed: 08/30/2022 10:04:39 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
05/06/2022 and conducted by Evaluator Araceli Canela

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20220506134523

FACILITY NAME:	WOODRIDGE RESIDENTIAL CARE II		FACILITY NUMBER:	486801578
ADMINISTRATOR:	CARTEL, JULLY		FACILITY TYPE:	740
ADDRESS:	738 OAKWOOD AVE.		TELEPHONE:	(707) 557-5939
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94591
CAPACITY:	6	CENSUS: 0	DATE:	08/25/2022
		UNANNOUNCED	TIME BEGAN:	04:30 PM
MET WITH:	Jully Cartel		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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9

Personal Rights

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), A. Canela arrived unannounced, for the purpose of delivering findings, regarding the above listed allegation. LPA previously gathered statements and reviewed records.
It was alleged resident R1 may have been handled in a rough manner by unidentified facility staff, sometime around January 2021. It was reported R1 went into Vallejo Kaiser Emergency Department around 1/15/2021 with behavior issues, such as being agitated and violent towards other residents and staff. LPA did not get any corroborating statements that staff were rough or violated resident R1's Personal Rights. LPA was unable to get a statement from resident R1.
Although the allegations may be true, or are valid, there is not a preponderance of evidence to prove the alleged violations did, or did not, occur. Therefore, the allegation for violation of Personal Rights is UNSUBSTANTIATED.

No citations issued

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Araceli Canela	TELEPHONE: (707) 588-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2022

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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