486803921-8-3-2023-21-AS-KMOA-CUJR93-20230809124853

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803921
Report Date: 08/03/2023
Date Signed: 08/03/2023 10:46:46 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
05/31/2023 and conducted by Evaluator David Leibert

COMPLAINT CONTROL NUMBER: 21-AS-20230531082558

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: 106	DATE:	08/03/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Carol Dowell		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Facility staff are not meeting residents needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst Leibert arrived unannounced for the purpose of delivering findings on this complaint. LPA met with Administrator and discussed the disposition. During the course of this investigation statements were taken from staff and witnesses, documents were obtained and reviewed, and five site visits made to the facility. The following determinations are made: Complainant alleges staff have left R1 in wheelchair all day which has caused R1's legs to swell; Memory Care Coordinator states R1 has lost mobility since placement in May of 2023 and that staff have encouraged R1 to engage in activities and to allow staff to elevate R1's legs; Home Health care was initiated in June of 2023 and has recommended that R1 lay down for several hours after meals to reduce stress on a pressure injury; Staff have satisfactorily complied with Home Health recommendations. Both Home Health personnel and R1's Power of Attorney Person have stated they believe that R1 is receiving appropriate care and that the facility is meeting R1's needs. Although the allegation may be true, or valid, based upon statements, documents, and observations, there is not a preponderance of evidence to prove the allegation is, or is not, true. Therefore, the allegation is UNSUBSTANTIATED. 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: 08/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

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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