486803921-8-3-2023-21-AS-KMOA-CUJR6C-20230809124431

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803921
Report Date: 08/03/2023
Date Signed: 08/03/2023 10:46:08 AM

Unfounded

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
07/19/2023 and conducted by Evaluator David Leibert

COMPLAINT CONTROL NUMBER: 21-AS-20230719125002

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:	11:00 AM

ALLEGATION(S):

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Staff not allowing resident to have visitor take resident out of facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst Leibert arrives 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 and documents were obtained and reviewed. The relative who has Power of Attorney for R1 has instructed facility staff to notify the POA in the event a visitor seeks to take R1 off the facility premises; There was a miscommunication during a recent incident involving R1 and a visitor who sought to take R1 outside while remaining on facility premises; Staff assumed that visitor was seeking to take R1 of the premises and advised visitor that the POA would need to be contacted; This resulted in the lodging of the complaint allegation; Subsequent statements from the Complainant confirms the miscommunication and complaint were result of misunderstanding and are not accurate. Based upon the statements, the allegation is UNFOUNDED, meaning that the allegation is not true and without a reasonable basis. The complaint is DISMISSED.

Report Left.

Unfounded

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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