496803860-10-1-2021-21-AS-CMAZ-C8ZPG4-20211122101742

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803860
Report Date: 10/01/2021
Date Signed: 10/01/2021 04:57:58 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
07/14/2021 and conducted by Evaluator Dina Alviso

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20210714133641

FACILITY NAME:	CLEARWATER AT SONOMA HILLS		FACILITY NUMBER:	496803860
ADMINISTRATOR:	WHITACRE, DERRICK		FACILITY TYPE:	740
ADDRESS:	710 ROHNERT PARK EXPRESWAY E		TELEPHONE:	(707) 710-7385
CITY:	ROHNERT PARK	STATE: CA	ZIP CODE:	94928
CAPACITY:	114	CENSUS:	DATE:	10/01/2021
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Derrick Whitacre-Administrator		TIME COMPLETED:	02:52 PM

ALLEGATION(S):

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Staff not providing adequate food services to residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst,(LPA) Dina Alviso, conducted a complaint inspection, and met with Administrator Derrick Whitacre.

LPA obtained copies of requested documenttion regarding facility food service procedures, and other related information for review. LPA reviewed records, conducted interviews, and observed a dining service during LPA's inspection. The investigation revealed that the facility has a standard regular food menu, and "specials of the day" that are offered each day. The Administrator stated that all food is cooked to order, and all food is always fresh. Residents meals are cooked once ordered and seated for dining, there are refreshments and/or soup or sald if wanted while waiting on the meal to be brought to the resident. The wait time per the Administrator is due to cooking the food to order; Food is never cooked in advance and in a warmer, it's all fresh and cooked to order.
Continued on LIC9099C...

Unsubstantiated

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: 10/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021

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-20210714133641

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: CLEARWATER AT SONOMA HILLS	FACILITY NUMBER: 496803860
	VISIT DATE: 10/01/2021

NARRATIVE

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LPA interviewed some residents of the facility individually regarding facility's food service/meals; The resident interviews revealed that the facility food was well made, tasted good, and was fresh food being served at the facility. There were a mix of views on time wait for meals being delivered to them during dining service, there were times of 15 minutes to about 20/30 minute waits for food orders; Each of these residents did state that the food is cooked to order and fresh. Some interviewed stated that if something is cooked fresh it is going to take about 15 to 20 or so minutes, and they don't have a concern about the wait time. LPA did not find any information from the interviews and/or records review that proved residents are not receiving adequate food service.

Based on LPAs observations, record reviews, interviews with staff, and other interested parties/residents, there is insufficient information to prove or disprove the allegation of Staff not providing adequate food services to residents. 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.

Exit interview conducted with Derrick Whitacre, Administrator.
No citations/No deficiencies.

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Dina Alviso	TELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021

LIC9099 (FAS) - (06/04)

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