496803905-2-11-2022-21-AS-HDBI-CCJW2W-20220315165500

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803905
Report Date: 02/11/2022
Date Signed: 02/11/2022 04:28:37 PM

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
10/18/2021 and conducted by Evaluator Dina Alviso

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20211018105233

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:	DATE:	02/11/2022
		UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Brooke Robichaud-Assistant Administrator		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Staff are not responding to the call button
Food service and storage is not of good quality

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alviso arrived unannounced to conduct a complaint investigation regarding the above allegations; LPA met with Assistant Administrator, Brooke Robichaud.

LPA reviewed resident and facility records, conducted interviews, and toured the kitchen regarding food storage and service. Per LPA's review and observations of the kitchen regarding food storage/food service, interviews with staff, and interviews with other related parties, the investigation revealed the following: The facility food supply was observed on two separate occasions, 12/29/21 & 2/11/22, to be stored appropriately per regulations. There were no food items left out in the kitchen and/or in the dining area for residents to choose from and consume outside of meal service, and no food items stored in the kitchen were found to be of bad quality during LPA inspections.
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: 02/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022

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-20211018105233

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: ARBOL RESIDENCES OF SANTA ROSA	FACILITY NUMBER: 496803905
	VISIT DATE: 02/11/2022

NARRATIVE

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The kitchen is not open to residents and only staff are to be in this area, currently there are doors that lock the kitchen to ensure only staff access the area. If residents were to go in the kitchen they would be directed out of this area, and to the dining area, per interviews with staff. The Chef stated there is not a problem she is aware of with residents wandering in the kitchen, and these doors are locked when the kitchen is not in use by kitchen staff.

Per file review and interviews, investigation revealed, resident (R1) was not on a one to one staffing plan but did have staff assistance with care needs, and with ambulating. R1 was a resident who was on hospice care on and off but had been on hospice while still residing at the facility. R1 was a one(1) person assist for transfers; R1 was a fall risk and was on a fall management care plan. R1 would need staff to push them in their wheelchair and/or if the resident was using their walker, a staff would need to be escorting R1 to and from wherever the resident was wanting /needing to go. Call bell records don't support and/or prove that residents call button was not being answered/responded to, and there was no information obtained that supported staff was not responded to regarding assistance to/with R1. Per interviews with staff, if a staff needs assistance with a resident and/or due to a resident fall, the staff calls for a nurse or medication technician for assistance. The staff stated that there are many times this is occurring as needed, and she gets all information on these calls reported to her as required. The caregivers do not pick up any residents if a resident falls and/or can't get up, they are to notify the Nurse or a medication technician to respond and assist.

The investigation has found there is differing information obtained from all parties interviewed; Based on the LPA's interviews, records/document reviews, observations, and related information obtained during the investigation, the allegations, Staff are not responding to the call button, Food service and storage is not of good quality 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 allegations are Unsubstantiated.
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: 02/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022

LIC9099 (FAS) - (06/04)

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