496803807-3-28-2022-21-AS-HDBI-CD7UCE-20220405152749

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803807
Report Date: 03/28/2022
Date Signed: 03/28/2022 04:24:50 PM

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
02/22/2022 and conducted by Evaluator Dina Alviso

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20220222150044

FACILITY NAME:	COGIR OF ROHNERT PARK		FACILITY NUMBER:	496803807
ADMINISTRATOR:	SARINE, STEVE		FACILITY TYPE:	740
ADDRESS:	4855 SNYDER LANE		TELEPHONE:	(707) 585-7878
CITY:	ROHNERT PARK	STATE: CA	ZIP CODE:	94928
CAPACITY:	45	CENSUS: 23	DATE:	03/28/2022
		UNANNOUNCED	TIME BEGAN:	03:35 PM
MET WITH:	Jose Acumabig-Administrator		TIME COMPLETED:	04:35 PM

ALLEGATION(S):

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Facility not providing adequate food service.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alviso conducted a complaint inspection, on 3/28/22, and met with the Administrator Jose Acumabig.

LPA requested resident (R1) records to review regarding the allegation listed above. The investigation revealed that resident (R1) is not a resident of the assisted living residential care facility for the elderly-license #496803807. The facility has a large portion of independent living units that are not part of the licensed RCFE/assisted living area.
Independent living residents do not receive the RCFE care services and supervision that is required as part of the RCFE license. LPA reviewed R1's lease agrrement that showed the resident was an independent resident., residing in an independent unit.

The allegations of facility not providing adequate food service, is UNFOUNDED, the Department has no jurisdiction over the "Independent Living" portion of Cogir of Rohnert Park.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Dina Alviso	TELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2022

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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