496830756-2-22-2024-21-AS-BMOS-D2TNWU-20240226095007

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496830756
Report Date: 02/22/2024
Date Signed: 02/22/2024 10:05:29 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
01/09/2024 and conducted by Evaluator David Leibert

COMPLAINT CONTROL NUMBER: 21-AS-20240109100757

FACILITY NAME:	MUIRWOODS MEMORY CARE		FACILITY NUMBER:	496830756
ADMINISTRATOR:	CAMILLE BROWN		FACILITY TYPE:	740
ADDRESS:	750 NORTH MCDOWELL BLVD		TELEPHONE:	(707) 775-4330
CITY:	PETALUMA	STATE: CA	ZIP CODE:	94954
CAPACITY:	80	CENSUS: 52	DATE:	02/22/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Lupe Villa-Guerrero		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff did not prevent an outbreak of scabies.
Staff not prevent outbreak of covid.

INVESTIGATION FINDINGS:

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Licensing Program Analyst Leibert arrives unannounced for the purpose of delivering findings on this complaint. This investigation included three site visits to the facility; a review of pertinent documents; as well as statements taken from staff and witnesses. The following determinations are made: In December of 2023, facility had several cases of Covid; Facility management followed appropriate protocols and made reasonable attempts to keep Covid positive residents isolated; There exists differing opinions as to whether or not the facility had an outbreak of scabies in the Fall of last year; Ten resident files were selected on a random basis and reviewed for indications of scabies; Ten of ten files were negative for any indications of scabies diagnosis; several files indicated various skin issues or rashes but none were identified as scabies. Although the complaint allegations may be true or valid, based upon statements and reviewed documents, there is not a preponderance of evidence to prove, or disprove, the allegations. Therefore, the allegations are UNSUBSTANTIATED.
Report left. No citations issued today.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Carla Martinez	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: David Leibert	TELEPHONE: (707) 588-5086
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024

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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