486803810-12-17-2024-21-AS-KMOA-DC9MRG-20241224085015

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803810
Report Date: 12/16/2024
Date Signed: 12/17/2024 10:05:43 AM

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
08/16/2024 and conducted by Evaluator Araceli Canela

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20240816133812

FACILITY NAME:	COGIR OF NORTH BAY		FACILITY NUMBER:	486803810
ADMINISTRATOR:	DOMIZIO, ANNEMARIE		FACILITY TYPE:	740
ADDRESS:	2261 TUOLUMNE ST		TELEPHONE:	(707) 552-3336
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94589
CAPACITY:	83	CENSUS: 53	DATE:	12/16/2024
		UNANNOUNCED	TIME BEGAN:	01:59 PM
MET WITH:	Executive Director/Administrator, Tracy Freudendahl.		TIME COMPLETED:	05:10 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Personal Rights

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) A. Canela arrived unannounced for the purpose of continuing complaint investigation and was greeted by Executive Director/Administrator, Tracy Freudendahl. LPA took additional statements and requested records.
It was alleged the personal rights of a resident were violated due to a lack of communication by facility staff. Resident R2 was ready to return to the facility after a hospital emergency visit and it was reported Hospital staff made several calls to the facility explaining R2 was ready to be discharged but they were not able to speak with Health Wellness director to coordinate discharge and were just allowed to leave messages by the front staff. It was reported R2 was admitted to the hospital on 8/9/2024 and on 8/13 hospital was trying to discharge R2, but was not able to discharge until 8/15.

Continue report see LIC9099-C

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: 12/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024

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-20240816133812

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 NORTH BAY	FACILITY NUMBER: 486803810
	VISIT DATE: 12/16/2024

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

Facility denies the allegations and express they always try to expedite, and conduct assessments of the residents to ensure they can meet their needs. Staff stated they attempted to conduct a visit at the hospital for R2 but the person in charge of giving day passes was not available and staff could not get in as the hospital was not issuing passes.

Although the allegation may be true, based on the above information, and statements received, there is not a preponderance of evidence to prove or, disprove, the allegation did occur. Therefore, the allegation is UNSUBSTANTIATED.

No citations issued today.

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Araceli Canela	TELEPHONE: (707) 588-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2