486803921-1-17-2025-21-AS-KMOA-DDJMYG-20250203090128

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803921
Report Date: 01/17/2025
Date Signed: 01/17/2025 08:13:52 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
10/03/2024 and conducted by Evaluator Araceli Canela

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20241003101824

FACILITY NAME:	LODGE AT GLEN COVE, THE		FACILITY NUMBER:	486803921
ADMINISTRATOR:	JASMINE SEIFFERT		FACILITY TYPE:	740
ADDRESS:	140 GLEN COVE MARINA ROAD		TELEPHONE:	(707) 653-4728
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94591
CAPACITY:	155	CENSUS: 142	DATE:	01/17/2025
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Jasmine Seiffert, Executive Director		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Staff do not respond to call bells in a timely manner
Resident hygiene needs not being met

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Canela arrived unannounced for the purpose of gathering additional information and delivering findings to the above allegations and met with Jasmine Seiffert, Executive Director.

In the course of the investigation LPA reviewed records, made observations and took statements. It was alleged staff do not respond to call bells in a timely manner in that it has been taking about one hour to respond when residents use their pull cord for assistance. Facility was not able to pull older call records because of their system but provided records for the week LPA requested for review. Pull cord records for resident R1 showed, 14 calls were answered under 2 minutes, 11 calls were answered under 5 minutes and 14 calls were answered under 10 minutes, for the one week review. LPA did observe the facility was also answering the majority of other resident calls under 10 minutes and only 3 calls were answered 15-17 minutes, but no documentation of calls answered upto an hour.

COntinue report see LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Araceli Canela
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2025

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-20241003101824

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: LODGE AT GLEN COVE, THE	FACILITY NUMBER: 486803921
	VISIT DATE: 01/17/2025

NARRATIVE

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Residents and staff interviewed did not corroborate the allegation and stated that calls are answered ok, but the facility could use more staff, back in November of 2024.

It was also alleged resident hygiene needs not being met for resident R1, in that staff are not available to assist with showers and the bathroom. Investigation revealed, resident was refusing showers. LPA reviewed documentation, for the month of October 2024 R1 received 10 showers and refused 3. Residents interviewed stated they get assistance but sometimes it takes a little longer; no information on how long and when.

Although the allegations may be true, based on the above information, and records reviewed, there is not a preponderance of evidence to prove or, disprove, the allegation did occur. Therefore, both allegations are UNSUBSTANTIATED at this time.

No citation issued.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Araceli Canela
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2025

LIC9099 (FAS) - (06/04)

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