496804058-3-30-2023-21-AS-HDBI-CQJVP5-20230403163606

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496804058
Report Date: 02/23/2023
Date Signed: 03/30/2023 10:53:42 AM

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
01/31/2023 and conducted by Evaluator Shannan Hansen

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20230131112554

FACILITY NAME:	WINDSONG OF SONOMA		FACILITY NUMBER:	496804058
ADMINISTRATOR:	SAVOIE, DEBORAH		FACILITY TYPE:	740
ADDRESS:	815 WOOD SORREL DRIVE		TELEPHONE:	(707) 776-2885
CITY:	PETALUMA	STATE: CA	ZIP CODE:	94954
CAPACITY:	95	CENSUS: 63	DATE:	02/23/2023
		UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Deborah Savoie, Administrator		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff are mismanaging residents medication

INVESTIGATION FINDINGS:

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***Amended Report***
Licensing Program Analyst (LPA) Hansen arrived unannounced to deliver amended findings on a report originally dated February 23, 2023. Additional information has been obtained and added to findings. LPA met with Administrator Deborah Savoie.
Staff are mismanaging residents’ medication – Complainant alleges staff are providing the wrong medication to residents. Through the process of this investigation LPA conducted interviews with four staff and Executive Director, a sample review of eight staff files including training records and of five resident records including Medication Administration Record’s (MARS), medication list, care plans, and LIC602’s. Interviews conducted revealed conflicting information and there was not a preponderance of evidence to prove medication is being mishandled. During the investigation reviewed, MARS had missing signatures and were addressed on February 23, 2023 case management.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Shannan Hansen	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2023

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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