496803001-2-24-2021-21-AS-BMOS-BYRSG7-20210303125128

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803001
Report Date: 02/23/2021
Date Signed: 02/24/2021 10:49:44 AM

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
10/26/2020 and conducted by Evaluator Victoria Willis

COMPLAINT CONTROL NUMBER: 21-AS-20201026133806

FACILITY NAME:	SARAH'S RETIREMENT HOME FOR DD SENIORS		FACILITY NUMBER:	496803001
ADMINISTRATOR:	ARAYA, SARAH		FACILITY TYPE:	740
ADDRESS:	791 MCCONNELL AVENUE		TELEPHONE:	(707) 528-6623
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95404
CAPACITY:	6	CENSUS: 4	DATE:	02/23/2021
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Sarah Araya, Administrator		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff is failing to address resident's incontinence needs

INVESTIGATION FINDINGS:

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

Licensing Program Analyst Willis met with Administrator, Sarah Araya to deliver findings regarding the above mentioned allegation. Visit was conducted remotely due to Covid-19 Precautions.

During investigation LPA conducted interviews and reviewed documents and pictures. Complaint alleges that resident was observed to be wearing three pairs of briefs in varying degrees of saturation indicating that resident's incontinence needs were not being met. Picture provided by Administrator and interview with facility staff indicated that resident wears a "pad" and a brief at night for incontinence. In addition to the pad and brief, a "pull-up" is worn during the day. Staff interviews indicated that resident had a medical emergency upon getting up in the morning causing them to have to go to the hospital and staff did not have an oppurtunity to change resident's briefs. Staff stated that resident was last changed at 4:30am.

Based on evidence, a finding that the complaint allegation that staff is failing to address resident's incontinence needs was 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.

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: 02/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2021

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

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
10/26/2020 and conducted by Evaluator Victoria Willis

COMPLAINT CONTROL NUMBER: 21-AS-20201026133806

FACILITY NAME:	SARAH'S RETIREMENT HOME FOR DD SENIORS		FACILITY NUMBER:	496803001
ADMINISTRATOR:	ARAYA, SARAH		FACILITY TYPE:	740
ADDRESS:	791 MCCONNELL AVENUE		TELEPHONE:	(707) 528-6623
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95404
CAPACITY:	6	CENSUS: 4	DATE:	02/23/2021
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Sarah Araya, Administrator		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff is mishandling resident's medication

INVESTIGATION FINDINGS:

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

Licensing Program Analyst Willis met with Administrator, Sarah Araya to deliver findings regarding the above mentioned allegations. Visit was conducted remotely due to Covid-19 Precautions.

During investigation LPA conducted interviews and reviewed documents and pictures. Complaint alleges that resident's medical emergency may have been caused by under medicating. Interview with noted individual clarified that the resident was going through a medication change per their doctor and the concern for under medicating was from that, not from concern that facility was mishandling resident's medication.

This agency has investigated the complaint alleging staff is mishandling resident's medication. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Unfounded

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: 02/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 2