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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496803905
Report Date: 09/10/2024
Date Signed: 09/10/2024 01:30:38 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
07/01/2024 and conducted by Evaluator Dina Alviso
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20240701120006
FACILITY NAME:ARBOL RESIDENCES OF SANTA ROSAFACILITY NUMBER:
496803905
ADMINISTRATOR:TAPIA, KARINAFACILITY TYPE:
741
ADDRESS:300 FOUNTAINGROVE PARKWAYTELEPHONE:
(707) 566-8600
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY:152CENSUS: DATE:
09/10/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Karina Tapia-Interim AdministratorTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Staff do not meet residents needs while in care
Staff are mistreating the residents
Staff are allowing the residents to be soiled and wet for extended periods of time
Staff are sleeping on their shifts
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alviso conducted a complaint investigation, on 9/10/24 at approximately 10:00am, and met with Interim Administrator/Health & Wellness Director, Karina Tapia,
LPA toured the facility. LPA reviewed six (6) resident records. LPA reviewed staff records, and facility records. LPA conducted interviews with six (6) staff, and other related parties regarding the allegations. LPA obtained copies of records. LPA reviewed records, obtained information, and interviewed staff, and other parties during the investigation. Investigation revealed that residents were on incontinent care services as part of their care plans. The investigation found no identified dates and times of incidents involving, residents not receiving care needs, residents being mistreated, and residents being left soiled and wet for extended periods of time. There was no information obtained regarding dates and times of staff sleeping on shift. During the investigation there was no information obtained to support a violation occurred regarding the allegations above. Based on the Department's investigation, interviews with staff and other parties, observations, and review of records, the allegation of "staff do not meet residents needs while in care, staff are mistreating the residents, staff are allowing the residents to be soiled and wet for extended periods of time, staff are sleeping on their shifts" are Unsubstantiated.

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 allegation(s) are Unsubstantiated.
No deficiencies cited.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Dina AlvisoTELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024
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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