486803808-8-8-2022-21-AS-KMOA-CJAP8S-20220915110602

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803808
Report Date: 08/05/2022
Date Signed: 08/08/2022 12:39:13 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
04/29/2022 and conducted by Evaluator Araceli Canela

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20220429171508

FACILITY NAME:	COGIR OF VALLEJO HILLS		FACILITY NUMBER:	486803808
ADMINISTRATOR:	DOWELL, CAROL		FACILITY TYPE:	740
ADDRESS:	350 LOCUST DRIVE		TELEPHONE:	(707) 266-6822
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94591
CAPACITY:	80	CENSUS: 37	DATE:	08/05/2022
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Helen Casas		TIME COMPLETED:	01:55 PM

ALLEGATION(S):

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9

Facility failed to meet residents care needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), A. Canela arrived unannounced, for the purpose delivering findings, regarding the above listed allegation. LPA met with Health and Wellness director, Helen Casas and toured the inside of this facility, made observations, and previously took statements and requested records.

It was alleged facility failed to meet residents care needs when staff did not assist R1 with incontinent care and was said to have been left in damped bed. LPA did not receive any corroborating statements from staff interviewed. Staff reported they assisted R1 and there were no complaints. LPA was unable to receive any statements from R1, due to R1 not in the facility.
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 Facility failed to meet residents care needs 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: 08/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2022

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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