496801635-6-10-2022-21-AS-HDBI-CFLU5X-20220621151730

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496801635
Report Date: 06/10/2022
Date Signed: 06/10/2022 03:14:54 PM

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
04/21/2022 and conducted by Evaluator Victoria Willis

COMPLAINT CONTROL NUMBER: 21-AS-20220421081044

FACILITY NAME:	HEALDSBURG SENIOR LIVING COMMUNITY		FACILITY NUMBER:	496801635
ADMINISTRATOR:	MORRIS, CYNTHIA		FACILITY TYPE:	740
ADDRESS:	725 GROVE STREET		TELEPHONE:	(707) 433-4877
CITY:	HEALDSBURG	STATE: CA	ZIP CODE:	95448
CAPACITY:	82	CENSUS: 32	DATE:	06/10/2022
		UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Administrator Cynthia Alvarez		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Neglect/Lack of Supervision

INVESTIGATION FINDINGS:

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Licensing Program Analyst Willis arrived unannounced to conduct additional investigation and deliver findings regarding the above mentioned allegation and met with Administrator Cynthia Alvarez.

During investigation, LPA conducted interviews and reviewed documents that included medical documents and a police report.

Neglect/Lack of Supervision - Complaint alleges that two residents are engaged is sexual actvity despite one resident being unable to consent due to cognition issues. Interviews revealed that staff observed an incident between two residents and reported it to their management. The police department, Long Term Care Ombudsman and the resident's family were notified and the resident with cognition issues was reassessed by their physician. Multiple interviews and conversations were conducted by different agencies and individuals with both residents due to some staff being concerned that resident was being manipulated or coerced into a sexual relationship. Interviews did not support this concern and involved residents denied being forced into a sexual relationship by the other resident.

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: 06/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022

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-20220421081044

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: HEALDSBURG SENIOR LIVING COMMUNITY	FACILITY NUMBER: 496801635
	VISIT DATE: 06/10/2022

NARRATIVE

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Continued from LIC809

Interviews indicate that once staff was aware of the potential sexual relationship, the facility followed Mandatory Reporting requirements and continue to monitor the residents. Facility also provided additional training for staff regarding Personal Rights of residents.

A finding that the complaint allegation Neglect/Lack of Supervision was unsubstantiated meaning that although the allegation may have happened there is not a preponderance of evidence to prove that the allegation occurred.

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Victoria Willis	TELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022

LIC9099 (FAS) - (06/04)

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