486803484-1-29-2024-21-AS-BMOS-D3PU9M-20240325152319

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803484
Report Date: 01/29/2024
Date Signed: 01/29/2024 12:44:40 PM

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
12/06/2023 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20231206093509

FACILITY NAME:	CORNERSTONE ASSISTED LIVING		FACILITY NUMBER:	486803484
ADMINISTRATOR:	SHELLEY REYES		FACILITY TYPE:	740
ADDRESS:	40 ORANGE TREE CIRCLE		TELEPHONE:	(707) 999-5029
CITY:	VACAVILLE	STATE: CA	ZIP CODE:	95687
CAPACITY:	130	CENSUS: 87	DATE:	01/29/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Shelley Reyes		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff did not meet resident's needs
Facility is unclean
Facility has an infestation of insects
Staff did not provide adequate food service
Staff did not provide a safe and comfortable environment for resident

INVESTIGATION FINDINGS:

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At approximately 9:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct an investigation into the above allegations. LPA met with Administrator Shelley Reyes, toured the building, reviewed records and interviewed staff. Based on records reviewed and interviews conducted, LPA did not find evidence to support the allegation that staff did not meet residents needs. LPA reviewed medical assessment regarding R1 which shows they are able to communicate their needs to staff. Resident assessments are updated every six months or as needed. LPA observed residents care plan was updated after staff observed a change in residents condition. Based on interviews conducted, staff conduct 2 hour checks on residents throughout the day. If a staff were to observe an issue with a resident or their room, they address the problem or call the appropriate department. Continued on LIC9099-C...

Unsubstantiated

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: 01/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024

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-20231206093509

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: CORNERSTONE ASSISTED LIVING	FACILITY NUMBER: 486803484
	VISIT DATE: 01/29/2024

NARRATIVE

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During the visual inspection of the facility, LPA observed clean hallways and exits that were free from obstructions. LPA reviewed pest prevention reports from Clark Pest Control, which show what work was done. Facility has a monthly visit from Clark's, to have preventative measures taken to control and prevent pests in the building. The reports did not comment on any abnormal pest infestation.
LPA reviewed menus prepared by the facility. LPA observed the food prepared and served by the facility to meet regulation. Facility posts a weekly menu for residents review, in addition to placing a daily menu at each table for residents to order from. If a resident is not pleased with the daily meal, the facility has an alternate menu for them to choose from. LPA was not able to find evidence to support the allegation of staff did not provide adequate food service.
LPA did not observe any areas of the building that were in disrepair or dangerous to residents. The temperature of the building was within regulation and each resident apartment has controls to regulation their own temperature. LPA observed a large activity room with scheduled activities for resident enjoyment. LPA was not able to find evidence to support the allegation that staff did not provide a safe and comfortable environment.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher Arnhold	TELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024

LIC9099 (FAS) - (06/04)

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