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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496803807
Report Date: 08/14/2025
Date Signed: 08/14/2025 05:26:28 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 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
07/21/2025 and conducted by Evaluator Dina Alviso
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20250721151111
FACILITY NAME:COGIR OF ROHNERT PARKFACILITY NUMBER:
496803807
ADMINISTRATOR:ORDING, KELLYFACILITY TYPE:
740
ADDRESS:4855 SNYDER LANETELEPHONE:
(707) 585-7878
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY:75CENSUS: 43DATE:
08/14/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kelly Ording-AdministratorsTIME COMPLETED:
05:40 PM
ALLEGATION(S):
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Staff are over-medicating the resident
Staff leaves the resident soiled
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alviso conducted a complaint inspection, on 8/14/2025 at approximately 10am, and met with the Administrator Kelly Ording.

Reporting party alleges "staff are over-medicating the resident, and staff leaves the resident soiled".

LPA reviewed facility records, including medication records, and MARs records. LPA reviewed resident's, R1, records, including care plan, hospice plan, and medication records/medication orders. LPA obtained copies as requested. Per staff file reviews, staff have required training, and fingerprint clearance as required.

Investigation revealed that per LPA's review of medication records, MARs records, and interviews, the resident, R1, was provided their medication as prescribed. In review of hospice file there was no record of medications issues, of medications not being provided to R1 as ordered.

Continued on LIC9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
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-20250721151111
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: COGIR OF ROHNERT PARK
FACILITY NUMBER: 496803807
VISIT DATE: 08/14/2025
NARRATIVE
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 Per review of hospice records, there was no information documented of hospice staff having concerns with resident care or incontinent care of R1, by facility staff.

The investigation revealed that there was differing information obtained from information provided to the Department regarding allegations. There was no information obtained that supported the violations had occurred.

Based on LPAs observations, record reviews, interviews with staff, and information obtained from other related party(s) there is insufficient information to prove or disprove the allegation of "staff are over-medicating the resident, and staff leaves the resident soiled". Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

No deficiencies cited.
Exit interview conducted with Kelly Ording, Administrator.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2