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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803921
Report Date: 09/22/2025
Date Signed: 09/22/2025 12:51:41 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 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
09/09/2025 and conducted by Evaluator Christopher Arnhold
COMPLAINT CONTROL NUMBER: 21-AS-20250909084115
FACILITY NAME:LODGE AT GLEN COVE, THEFACILITY NUMBER:
486803921
ADMINISTRATOR:JASMINE SEIFFERTFACILITY TYPE:
740
ADDRESS:140 GLEN COVE MARINA ROADTELEPHONE:
(707) 653-4728
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:155CENSUS: 138DATE:
09/22/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Tamia LindsayTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff did not assist resident in a timely manner.
Facility is not sanitary and in good repair
Staff did not keep facility free from pests.
INVESTIGATION FINDINGS:
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At approximately 09:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this faciity unannounced to conduct an investigation into the above allegations. LPA met with Activity Director Tamia Lindsay, toured the building, interviewed staff and reviewed records. Based on interviews conducted, LPA was not able to find evidence that staff did not assist resident in a timely manner. The facility call system is designed to log each call with time of activation, location and response time, however the system is not fully operational and does not log any details. The call system alerts staff in the medication room, who then relay the location and resident to the caregivers by text. LPA was informed that when staff leave the medication room, the medication technicians take turns returning every five minutes to check the call system. This occurs on all shift. Facility is undergoing a leadership change and the call system is in the process of repair or replacement. During the course of this investigation, LPA toured the facility in search of items or areas that were unsanitary or in need of repair. LPA learned there were several laundry machines that were not operational, but facility purchased replacements. During the timeframe while they were down, facility staff would take resident laundry to a local laundry mat to ensure resident laundry was cleaned per their schedule. Based on Interviews conducted, there were no delays in laundry service during this time. Continued on LIC9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2025
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-20250909084115
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: LODGE AT GLEN COVE, THE
FACILITY NUMBER: 486803921
VISIT DATE: 09/22/2025
NARRATIVE
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The facility locks their front door after business hours to protect residents from people coming into the building without staff knowledge. To the side of the front door is a door bell with a sign informing visitor to press the button to announce their presence. A sign is posted on the front door with two telephone numbers for visitors to call if the door bell does not receive a response. LPA tested the door bell, which was operational, and observed it could be heard from the medication room hallway.
Based on interviews conducted and visual observations, the facility is dealing with an ant problem. The facility has a contract with a pest exterminator company and is in communication with them regarding the increase in ants recently. LPA observed bait traps located throughout the facility. LPA was informed that when ants are observed in localized areas, the company will come and spray the areas to address the issue. LPA observed the facility is working to address the ant problem.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2