496801635-10-14-2021-21-AS-HDBI-C7ZVME-20211021163326

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496801635
Report Date: 10/14/2021
Date Signed: 10/14/2021 03:49:05 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
09/03/2021 and conducted by Evaluator Victoria Willis

COMPLAINT CONTROL NUMBER: 21-AS-20210903102026

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: 31	DATE:	10/14/2021
		UNANNOUNCED	TIME BEGAN:	09:28 AM
MET WITH:	Administrator, Tracey Mease		TIME COMPLETED:	03:48 PM

ALLEGATION(S):

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Facility did not follow Covid-19 guidelines
Resident needs were not met
Staff denied visitation to resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst Willis arrived unannounced to deliver findings regarding the above-mentioned complaint allegations and met with Administrator, Tracey Mease.

During investigation, LPA made multiple attempts to gather additional information and evidence regarding the complaint allegations but was unsuccessful. LPA reviewed documents including CCL guidance on Covid-19 and previous complaints investigated during the same timeframe for this facility.

Complaint alleges that a resident of the facility contracted Covid while in the facility and subsequently passed away in March of 2021. The allegation goes on to say that Covid was brought in by facility employees who were unvaccinated which led to the transmission of Covid to the residents resulting in some residents passing away.

Contiued on LIC9099

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: 10/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021

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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Control Number 21-AS-20210903102026

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: 10/14/2021

NARRATIVE

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Continued from LIC9099

The complaint also alleges that family would leave messages to speak to the resident or attempt to set up appointments through the coordinators to visit, but the coordinators were rude and attempts to visit were denied. Additionally, witnesses saw people on the floor and alleged that resident wasn’t drinking water on their own and facility did not make resident drink water.

Additional information regarding the allegation that witnesses saw resident’s needs not being met was not provided. The time-frame of the alleged incidents was between approximately December 2020 and March 2021. On January 1, 2021 a Non-Compliance Conference was conducted to address areas of concern including but not limited to the facility’s Covid-19 protocols and the Covid-19 Mitigation Plan. Facility was cited March 5, 2021 for failing to meet residents needs due, in part, to lack of staffing. Non-compliance regarding Covid-19 protocols and failure to meet residents needs were previously addressed. Based on review of records, the noted resident was diagnosed with Covid-19 prior to the Covid-19 vaccinations being available.

Attempts to gain clarification regarding the allegation that staff denied visitation to resident was unsuccessful. The Provider Information Notice that was in effect during the time of the allegation (PIN 20-38-ASC) indicated that “At all times when visitation is restricted under this waiver, licensees must allow indoor visits on the facility premises when all of the following requirements are met: 1. There have been no new transmissions of COVID-19 at the facility for 14 days. 2. The facility is not experiencing staff shortages. 3. The facility has adequate supplies of PPE and essential cleaning supplies.” It was not clear if staff allegedly denied visitation in violation of this guidance. Additionally, it was not clarified whether other visitation options were offered like window visitation, outdoor visitation or virtual visitation.

A finding that the complaint alleging that Facility did not follow Covid-19 guidelines, Resident needs were not met, and Staff denied visitation to resident was unsubstantiated meaning that although the allegations may have happened there is not a preponderance of evidence to prove that the allegation occurred.

No deficiencies cited during this inspection.

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Victoria Willis	TELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021

LIC9099 (FAS) - (06/04)

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