486803809-5-9-2023-21-AS-HDBI-CSTRJQ-20230615130420

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803809
Report Date: 05/09/2023
Date Signed: 05/09/2023 01:49:02 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
05/01/2023 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20230501162425

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: 35	DATE:	05/09/2023
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Robin Stouder		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Facility is not in good repair
Staff speak inappropriately to residents
Staff do not meet residents' dietary needs
Staff do not monitor residents for change in condition

INVESTIGATION FINDINGS:

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At approximately 8:45AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an investigation into the above allegations. LPA met with Executive Director Robin Stouder, toured the facility, interviewed staff and residents and reviewed records. The assisted living section of this facility only encompasses 35 apartments out of 162. The 35 assisted living apartments are located on the first floor of 1 building. The second story of the assisted living building has 34 independent living apartments. The remaining 93 apartments are in separate buildings. LPA learned the facility is 3 years into a 5 year project to replace the siding throughout the various buildings on the property. During this project, 2 of the independent living apartments have had a rodent problem. LPA interviewed facility maintenance Director and learned the facility has a contract with Ecolab to address the issue. A resident that occupies one of the rooms has refused to allow entry for Ecolab. Facility has taken steps to ensure the Ecolab has access. There have been zero cases of rodents in the assisted living areas of the facility. 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: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

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-20230501162425

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: 05/09/2023

NARRATIVE

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LPA interviewed staff and residents regarding the interactions of staff with residents. Based on interviews conducted with residents, staff interact with residents in a friendly and caring manner. If a staff raises their voice, it is not done in anger, rather to allow the resident to hear what they are saying. LPA spoke with staff from the dining room, housekeepers and care providers. There were no instances where a staff heard of other staff yelling or speaking inappropriately to residents. The dining area of the facility is arranged similar to a restaurant. Individuals seat themselves at tables and fill out a menu request. Dining room servers take the request and provide to the kitchen. The meal is then served when the food is ready. Residents have the option of two entrees, soup or salad, several side dishes, desserts and beverages. If residents want even more options, there is an alternate menu with nine more options that is available between the hours of 10am and 6pm. LPA interviewed staff about the assessments, reappraisals and observations of residents. Assisted living residents receive reappraisals bi-annually or as needed. Assisted Living Residents are checked on approximately every hour or when staff are called for assistance. Independent residents do not receive care or supervision by facility staff. The facility requests a daily check in for independent residents. If an independent resident has not checked in by 9AM, the front desk will telephone the individual. If there is no answer, a physical visit is made by staff. If no answer at the door, staff will enter the room to ensure the resident is safe. LPA reviewed call log records for April through May, 2023. Every morning, by 9AM, the previous days requests for service are reviewed by management. If a call response was longer than 10 minutes, an investigation is conducted to determine why there was a delay. Based on interviews conducted, it is common for the care staff to assist the resident before resetting the pendant which results in a response time of more than 10 minutes.

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.

No citations issued during this visit.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher Arnhold	TELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

LIC9099 (FAS) - (06/04)

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