496801635-9-2-2021-21-AS-HDBI-C75TWA-20210923150513

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496801635
Report Date: 09/02/2021
Date Signed: 09/02/2021 04:55:17 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/15/2021 and conducted by Evaluator Victoria Willis

COMPLAINT CONTROL NUMBER: 21-AS-20210715090408

FACILITY NAME:	HEALDSBURG SENIOR LIVING COMMUNITY		FACILITY NUMBER:	496801635
ADMINISTRATOR:	MEASE, TRACEY		FACILITY TYPE:	740
ADDRESS:	725 GROVE STREET		TELEPHONE:	(707) 433-4877
CITY:	HEALDSBURG	STATE: CA	ZIP CODE:	95448
CAPACITY:	82	CENSUS: 30	DATE:	09/02/2021
		UNANNOUNCED	TIME BEGAN:	01:54 PM
MET WITH:	Administrator, Tracey Mease		TIME COMPLETED:	04:55 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are not following COVID-19 related protocols
Staff did not treat residents with dignity and respect
Unlawful Eviction
Staff yell at other staff in front of residents

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analysts Willis and Gonzalez-Campos arrived unannounced to deliver findings regarding the above-mentioned complaint allegation Administrator, Tracey Mease.

Staff are not following COVID-19 related protocols – Complaint alleges that a Covid positive staff was requested to return to the facility prior to the end of their quarantine period by facility management. Staff denied that they were requested to return. During investigation, LPA questioned whether facility was able to disinfect per their Mitigation Plan considering there were no housekeepers. Administrator stated that they were still disinfecting per their Mitigation Plan but was unable to provide documentation.

Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Victoria Willis	TELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021

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-20210715090408

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: HEALDSBURG SENIOR LIVING COMMUNITY	FACILITY NUMBER: 496801635
	VISIT DATE: 09/02/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Continued from LIC9099

Unlawful Eviction – Complaint alleges that facility management gave resident moving boxes and told them to leave the facility. Some interviews indicated that facility staff verbally told resident’s responsible party that they needed to find new placement, but facility staff indicated that resident was not evicted and instead indicated to staff that they wanted to move. Based on LPA observation and interview, involved resident is still residing in the facility and was not provided a written eviction letter which is required by regulation.

Staff yell at other staff in front of residents – Complaint alleges that facility management yell at staff in front of residents. Some interviews indicated that staff are yelled at by managers while others deny hearing staff yell. LPA was unable to confirm whether residents were present when the alleged incidents occurred.

Staff did not treat residents with dignity and respect – Complaint alleges that facility management yelled at one resident who voiced their displeasure during a planned activity and another resident was yelled at by facility management and told to leave the facility while moving boxes were thrown at them. One involved resident denied being yelled at by facility staff and stated they did not feel disrespected during the incident. The other involved resident indicated that they did not have moving boxes thrown at them and could not recall if staff yelled at them.

A finding that the complaint allegations, Staff are not following COVID-19 related protocols, Staff did not treat residents with dignity and respect, Unlawful Eviction, and Staff yell at other staff in front of residents is unsubstantiated meaning that although the allegation may have happened there is not a preponderance of evidence to prove that the allegation occurred. We have therefore dismissed the complaint.

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Victoria Willis	TELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2