486803921-7-6-2023-21-AS-HDBI-CUCP3E-20230803105726

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803921
Report Date: 07/06/2023
Date Signed: 07/06/2023 11:51:15 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
05/18/2023 and conducted by Evaluator David Leibert

COMPLAINT CONTROL NUMBER: 21-AS-20230518170036

FACILITY NAME:	LODGE AT GLEN COVE, THE		FACILITY NUMBER:	486803921
ADMINISTRATOR:	SANDOVAL, GRACE		FACILITY TYPE:	740
ADDRESS:	140 GLEN COVE MARINA ROAD		TELEPHONE:	(707) 592-1157
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94591
CAPACITY:	155	CENSUS: 105	DATE:	07/06/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Grace Sandoval		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility staff do not provide adequate hygiene service.
Facility staff do not provide adequate food service.
Staff do not respond to call bells in a timely manner.
Facility is in disrepair.

INVESTIGATION FINDINGS:

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This complaint has been investigated through multiple site visits, statements from witnesses, and review of pertinent documents. Today, Licensing Program Analyst Leibert arrives unannounced and meets with the Administrator to discuss the findings: R1's care plan requires weekly bathing and assistance with grooming; Care notes report an incident when R1 refused to get out of bed; Shower logs fro R1 indicate R1 refused showers on 5/19,5/23,6/2,6/16; LPA Leibert sampled food service on three occasions and found food to be fresh, nourishing and warm or hot; A sampling of call response logs over a 3 day period resulted in most calls answered in less than one minute with one 9 minute response and one 10 minute response; LPA noted the facility to be clean and in good repair during 3 recent unannounced site visits; Facility has no maintenance record of repair to R1's toilet but reports a service call to clean toilet on 5/15. Although the allegations may be true, based on statements, documents, and observations, there is not a preponderance of evidence to prove the allegations did, or did not, occur. Therefore, the allegations are UNSUBSTANTIATED.
No citations issued today. Report left.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Carla Martinez	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: David Leibert	TELEPHONE: (707) 588-5086
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

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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