486803809-8-7-2023-21-AS-HDBI-CUKNZV-20230810105458

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803809
Report Date: 08/07/2023
Date Signed: 08/07/2023 12:49:09 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
08/02/2023 and conducted by Evaluator Farhaan Sarangi

COMPLAINT CONTROL NUMBER: 21-AS-20230802091613

FACILITY NAME:	COGIR OF VACAVILLE		FACILITY NUMBER:	486803809
ADMINISTRATOR:	STOUDER, ROBIN		FACILITY TYPE:	740
ADDRESS:	799 YELLOWSTONE DRIVE		TELEPHONE:	(707) 447-7496
CITY:	VACAVILLE	STATE: CA	ZIP CODE:	95687
CAPACITY:	49	CENSUS: 32	DATE:	08/07/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Administrator, Robin Stouder		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not ensure food of good quality is being served to residents in care
Staff speak inappropriately to residents in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Cogir of Vacaville for the purpose of opening a complaint and conducting a complaint investigation inspection. LPA was greeted at the door by the front desk receptionist, and was granted access into the facility. Administrator, Robin Stouder arrived 15 minutes later.

During the course of the investigation, LPA interviewed residents and staff. LPA reviewed resident records and facility record(s). In addition, LPA toured the facility kitchen and inspected perishable and non-perishable foods that were found to be appropriate during the inspection.

Complaint alleges that staff do not ensure food of good quality is being served to residents in care. Based on interviews, LPA could not prove or disprove the allegation. During interviewing of residents in care, there were inconsistent statements that were made during the course of the investigation. (Report continued on LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5029
LICENSING EVALUATOR NAME: Farhaan Sarangi	TELEPHONE: 707-588-5034
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2023

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-20230802091613

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: COGIR OF VACAVILLE	FACILITY NUMBER: 486803809
	VISIT DATE: 08/07/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Furthermore, LPA reviewed facility records which were found to be appropriate during the document review. LPA reviewed the LIC 602's as it relates to Special Diets and observed no concerns with the LIC 602's regarding residents in care.

Complaint alleges that Staff speak inappropriately to residents in care. Based on interviews that were conducted, LPA learned of no concerns as it relates to the allegation. Furthermore, residents in placement reported no concerns regarding staff members to resident interactions.

A finding that the complaint allegations of Staff do not ensure food of good quality is being served to residents in care and Staff speak inappropriately to residents in care are unsubstantiated meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview was conducted and a copy of this was report was signed and given to the Administrator.

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5029
LICENSING EVALUATOR NAME: Farhaan Sarangi	TELEPHONE: 707-588-5034
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2