486803810-8-21-2024-21-AS-KMOA-DA5TGG-20241017144309

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803810
Report Date: 08/21/2024
Date Signed: 08/21/2024 04:40:03 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
06/20/2024 and conducted by Evaluator Araceli Canela

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20240620122804

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: 54	DATE:	08/21/2024
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Tracy Freudendahl, Executive Director/Administrator		TIME COMPLETED:	03:31 PM

ALLEGATION(S):

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Staff do not ensure that residents are served foods of good quality
Staff did not ensure that the facility is maintained in good repair

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) A. Canela arrived unannounced for the purpose of continuing complaint investigation regarding the above allegations and met with Executive Director/Administrator, Tracy Freudendahl.

This investigation included site visits to the facility; statements taken and LPA observations. It has been alleged facility staff do not ensure that residents are served foods of good quality, in that foods are served burned or cold. LPA took several statements from residents and no one corroborated the allegation. Residents expressed they like the food and have never had an issue with food being burned or cold. It was also alleged staff did not ensure the facility is maintained in good repair in that the outside smoking area gazebo tent is torn to shreds and water fountains are not operational. LPA observed the tent is in perfect condition. Facility staff expressed it was replaced about a month and a half ago due to needing a new cover but it was never in shreds. LPA observed water fountain next to the activity room that is not operational and Executive Director explained they were turned off as a precaution ever since Covid-19. They will remove the water fountains as they have several areas with available water and hydrating carts. 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.
Report email. No citations issued today.

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: 08/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024

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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