496803860-3-28-2023-21-AS-CMAZ-CR3W2S-20230420165450

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803860
Report Date: 03/28/2023
Date Signed: 03/28/2023 03:47:12 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
01/06/2023 and conducted by Evaluator Dina Alviso

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20230106161627

FACILITY NAME:	CLEARWATER AT SONOMA HILLS		FACILITY NUMBER:	496803860
ADMINISTRATOR:	ORTIZ, JUSTINE M.		FACILITY TYPE:	740
ADDRESS:	710 ROHNERT PARK EXPRESWAY E		TELEPHONE:	(707) 710-7385
CITY:	ROHNERT PARK	STATE: CA	ZIP CODE:	94928
CAPACITY:	114	CENSUS: 89	DATE:	03/28/2023
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Janna O'Sullivan-Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility does not have a full time administrator/director

Facility staff served raw meal(s) to resident(s).

Facility staff does not shower resident on scheduled day(s).

INVESTIGATION FINDINGS:

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

Licensing Program Analysts(LPAs) Alviso and Sarangi, conducted a complaint inspection, on 3/28/23 at approximately 8:45am, and met with Janna O'Sullivan, Administration staff.

LPA reviewed resident and staff records, conducted interviews, and obtained copies of requested facility records. The investigation revealed that there has been Administrative coverage as required by regulation.LPA received an LIC500 dated 11/3/22 showing Administrator Justine Ortiz was hired to provide Administrative duties until a full time Administrator could be found that met qualifications of regulation and the facility. The facility reported who is covering the Administrator position and has submitted required qualifying documentation to the Licensing Agency.

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: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

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-20230106161627

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: CLEARWATER AT SONOMA HILLS	FACILITY NUMBER: 496803860
	VISIT DATE: 03/28/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The Regional Office for Clearwater was providing coverage prior to Justine Ortiz coming over on a regular schedule but it was using staff that were covering their actual hired positions as well as trying to cover the Administrator position. The investigation didn't find sufficient information to support a violation had occurred.

Per interviews, there has been differing information regarding raw meats are being served in meals. The facility was cited on 10/27/2022 regarding raw/undercooked meat having been served in resident meals. The facility did correct this citation from 10/27/2022. During this investigation, there was no information obtained to support that there was a violation regarding food service, the serving of raw meats in meals.

In review of records, and interviews with staff and other parties, resident showers are scheduled per the residents care plan, and staff also provide showers/bathing as needed for different reasons/incidents. Residents may refuse showers, and staff will try and encourage the resident(s) to take the shower but will document the refusal if resident continues to say no to their shower. A resident may choose to reschedule if not wanting the shower/bathing for some reason; A resident will be put into available time frame they choose that's open for showering/bathing. The investigation didn't find sufficient information to support a violation had occurred.

Per LPA's review of records, observations, and interviews with staff and other parties, which provided differing information regarding allegations. There was no information found to support violations occurred, the facility does not have a full time administrator/director, the facility staff served raw meal(s) to resident(s), facility staff does not shower resident(s) on scheduled day(s).

Based on the investigation, interviews, and record reviews, Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are Unsubstantiated.

No deficiencies and/or citations issued today.
Exit interview conducted with Administration staff Janna O'Sullivan.

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Dina Alviso	TELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2