496803905-9-10-2024-21-AS-BMOS-DBEPXB-20241127104204

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 ROSA		FACILITY NUMBER:	496803905
ADMINISTRATOR:	TAPIA, KARINA		FACILITY TYPE:	741
ADDRESS:	300 FOUNTAINGROVE PARKWAY		TELEPHONE:	(707) 566-8600
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95403
CAPACITY:	152	CENSUS:	DATE:	09/10/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Karina Tapia-Interim Administrator		TIME 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 Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Dina Alviso	TELEPHONE: (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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