496803905-12-29-2021-21-AS-CMAZ-CAC3M2-20220103172136

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803905
Report Date: 12/29/2021
Date Signed: 12/29/2021 05:46:00 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
07/06/2021 and conducted by Evaluator Dina Alviso

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20210706121953

FACILITY NAME:	ARBOL RESIDENCES OF SANTA ROSA		FACILITY NUMBER:	496803905
ADMINISTRATOR:	SORIANO, MARIELE		FACILITY TYPE:	741
ADDRESS:	300 FOUNTAINGROVE PARKWAY		TELEPHONE:	(707) 566-8600
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95403
CAPACITY:	152	CENSUS: 90	DATE:	12/29/2021
		UNANNOUNCED	TIME BEGAN:	12:35 PM
MET WITH:	Brooke Robichaud-Administrator		TIME COMPLETED:	05:45 PM

ALLEGATION(S):

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Residents do not receive medications on time
Residents are not showered due to lack of staff

INVESTIGATION FINDINGS:

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LPA conducted a complaint inspection, on 12/29/21 at approximately 12:35pm, and met with Brooke Robichaud, Administrator.
LPA toured the memory care, reviewed resident records, medication records, and other policy and procedure records. The LPA conducted interviews with staff and other related parties regarding the complaint investigation. The investigation revealed that there have been discussions between care staff/medication technicians, and management staff regarding work schedues, work shifts,work duties, and work policy and procedures regarding calling off when scheduled to work, and ensuring staff contact their Supervisor. Per interviews with Management staff , S1, S3 and S8, this something that is still being worked on and continues to be monitored, and documented.
Per S1, S3, and S8, no residents have been neglected at any time, residents are very well cared for by all the staff. It is policy to report if a resident refuses their shower and/or staff will report if there is a problem giving a resident a shower, care staff can't just refuse to complete care services to a resident. The Supervisor must be contacted and they will address the issue as needed to ensure resident is well, and cared for.
Continued on LIC9099...

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: 12/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2021

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-20210706121953

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: ARBOL RESIDENCES OF SANTA ROSA	FACILITY NUMBER: 496803905
	VISIT DATE: 12/29/2021

NARRATIVE

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Per interviews, residents' have received medications as ordered in AL and in Memory Care, and there has not been a problem with meeting this; Facility medication policy has all medication pass times noted, 5am to 7am, 8am to 10am, 11am to 1pm, and 8pm to 10pm. If there are any medications that are needed to be given after 10pm, PRN medications which are given as needed, these are provided by the floating med tech on shift, 10pm to 6am, for both AL & Memory Care.

The investigation has found there is differing information obtained from all parties interviewed; Based on the interviews, records/document reviews, medication record reviews, and related information obtained during the investigation, the allegations, Residents do not receive medications on time, Residents are not showered due to lack of staff 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) is Unsubstantiated.

No citations issued.
No deficiencies cited during today’s visit.
Exit interview was conducted.

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Dina Alviso	TELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2021

LIC9099 (FAS) - (06/04)

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