486803612-10-13-2022-21-AS-KMOA-CKSKVS-20221102081447

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803612
Report Date: 10/13/2022
Date Signed: 10/13/2022 01:11:15 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
09/01/2022 and conducted by Evaluator Dominic Tobola

COMPLAINT CONTROL NUMBER: 21-AS-20220901170138

FACILITY NAME:	GARDEN OF EDEN		FACILITY NUMBER:	486803612
ADMINISTRATOR:	MILTON, SHERYL		FACILITY TYPE:	740
ADDRESS:	115 MENLO COURT		TELEPHONE:	(707) 654-8307
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94589
CAPACITY:	6	CENSUS: 3	DATE:	10/13/2022
		UNANNOUNCED	TIME BEGAN:	12:31 PM
MET WITH:	Steven Milton, Administrator		TIME COMPLETED:	01:20 PM

ALLEGATION(S):

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Personal Rights
Facility failed to provide basic services to resident in care

INVESTIGATION FINDINGS:

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On 10/13/2022 LPA Tobola arrived unannounced for the purpose of delivering complaint findings and was greeted by Administrator, Steven Milton. LPA toured the facility, conducted interviews, reviewed documents and made observations.

Complaint alleges facility violated resident's (R1) personal rights regarding R1 being denied the right to medical treatment. Upon interview with R1, LPA found that R1 has been aware of their medical condition but had refused or delayed medical care services on several occasions to treat R1's condition. In addition, LPA interviewed Administrator who stated that they spoke with R1 multiple times encouraging and providing support for the medical treatment. However, R1 continued to refuse treatment. Due to conflicting information there is not enough corroborating evidence towards the allegation.
Continue onto LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Dominic Tobola	TELEPHONE: (707) 588-5081
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022

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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Control Number 21-AS-20220901170138

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: GARDEN OF EDEN	FACILITY NUMBER: 486803612
	VISIT DATE: 10/13/2022

NARRATIVE

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Complaint alleges facility failed to provide basic services to resident in care. Upon review of R1's admissions agreement the Administrator is responsible for arranging transportation to medical appointments. Upon interview with resident R1 and Administrator, LPA found that R1 required transportation to a medical center located in Napa for R1's medical treatment. In an interview LPA found that the Administrator had assisted in arranging for R1 in finding transportation by contacting outside medical transportation services. However, the medical transportation service required confirmation and interview with R1. R1 told LPA that they were aware of needing to contact the medical transportation services to confirm a pickup date but R1 had not done so in a timely manner.

Based on the interviews, record review, and information obtained during the investigation the allegations personal rights and facility failed to provide basic services to resident in cares are UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Dominic Tobola	TELEPHONE: (707) 588-5081
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022

LIC9099 (FAS) - (06/04)

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