496804150-2-1-2024-21-AS-BMOS-D2DQ9G-20240212105819

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496804150
Report Date: 02/01/2024
Date Signed: 02/01/2024 09:08:52 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
10/04/2023 and conducted by Evaluator Shannan Hansen

COMPLAINT CONTROL NUMBER: 21-AS-20231004154753

FACILITY NAME:	WINDSONG OF SONOMA		FACILITY NUMBER:	496804150
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: 77	DATE:	02/01/2024
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	MARY MCCLURE, Administrator		TIME COMPLETED:	09:10 AM

ALLEGATION(S):

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Staff are not ensuring resident has privacy
Staff are discriminating against resident
Staff are threatening resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Hansen conducted a complaint investigation regarding the allegations listed above. LPA arrived unannounced on this day for the purpose of delivering findings of the above allegations. LPA met with Administrator, Mary McClure.

Staff are not ensuring resident has privacy - According to complainant, staff are coming into resident (R1)’s room without permission or any notice. R1 was relocated from a sister facility during an emergency evacuation 4/2023. Facility policy is to clean resident’s rooms weekly/as needed and conduct room checks, which began upon R1’s arrival. Facility and R1 had an agreement regarding room checks and cleaning. Later, R1 expressed they did not want this service and the facility complied. Based on LPAs interviews, record review, and observations, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, staff are not ensuring resident has privacy, did or did not occur, therefore the allegation is Unsubstantiated.
Continue on LIC9099-C

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: 02/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024

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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Control Number 21-AS-20231004154753

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: WINDSONG OF SONOMA	FACILITY NUMBER: 496804150
	VISIT DATE: 02/01/2024

NARRATIVE

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Staff are discriminating against resident -& Staff are threatening resident - According to reporting party , an incident occurred at facility during dining hours between R1 and a staff (S1) member. Based on LPAs interview with witness resident and staff it was revealed that R1 was verbally loud and disruptive in the dining area. LPA was unable to obtain clarification regarding reason for R1’s outburst. Administrator was made aware of incident and had a meeting with R1. After the meeting, Administrator provided a letter to R1 summarizing their conversation and informing of facilities polices. The letter informed if facilities policies are violated moving forward an eviction may be warranted. LPA obtained a copy of the notice provided to R1. Reporting party informed LPA based on the dining room incident and letter received R1 felt threatened and discriminated against. The investigation did not reveal information to support these allegations. Based on LPA’s record review, interviews conducted, and observations, although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations staff are discriminating against resident & staff are threatening resident did or did not occur, therefore the allegations are Unsubstantiated.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Shannan Hansen	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024

LIC9099 (FAS) - (06/04)

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