496830756-2-1-2024-21-AS-BMOS-D2DQJC-20240212111230

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496830756
Report Date: 02/01/2024
Date Signed: 02/01/2024 01:57:29 PM

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
10/24/2023 and conducted by Evaluator Shannan Hansen

COMPLAINT CONTROL NUMBER: 21-AS-20231024151946

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: 55	DATE:	02/01/2024
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Camille Brown, Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Insufficient staffing to meet residents care needs
Staff do not have adequate training

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

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, Camille Brown.

Insufficient staffing to meet residents care needs – Complainant alleges due to lack of staffing, tasks such as laundry are not being completed as scheduled, leaving residents without clean clothing and unable to assist residents with activities of daily living (ADL)’s, toitleting & hygiene services. LPA’s record review & interview with administrator revealed facility has 6 med techs & 23 caregivers. LPA was informed one of the washing machines has had some operating issues and the facility is addressing repairs. Administrator informed LPA of alternative plan if there is a backlog of laundry to ensure it is completed timely. Interviews were conducted with (5) staff who were consistent in informing LPA residents’ rooms are cleaned the same day as their laundry day. Three housekeepers work 5 days a week washing laundry and caregivers will help if requested. LPA obtained staff schedule to confirm sufficient staffing. Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Shannan Hansen
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)

Page: 1 of 2

Control Number 21-AS-20231024151946

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: MUIRWOODS MEMORY CARE	FACILITY NUMBER: 496830756
	VISIT DATE: 02/01/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

On morning of 11/2/2023 while touring facility LPA observed identified resident (R1) to be well dressed in good hygiene and walking hallways with staff. On early afternoon of 11/13/2023 while at facility LPA observed R1 sitting in hallway chair fully dressed in clean cloths and groomed. LPA observed R1’s closet having plenty of clean clothes (pants, shirts, undergarments able to be worn (see pics)) along with laundry basket of clothes and bed linen. 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, Insufficient staffing to meet residents care needs, did or did not occur, therefore the allegation is Unsubstantiated.

Staff do not have adequate training – Complainant alleges staff are not adequately trained due to sending residents out to the hospital several times for various behaviors and incidents when they should be able to handle behavioral issues instead of sending out. LPA obtained training records of 5 staff that revealed staff have required trainings per regulation including Dementia Care training. Based on LPAs record review resident (R1) was sent out of the facility on two occasions due to change of condition and returned with diagnosis of UTI. LPA did not obtain any additional information that facility staff are not adequately trained and/or sending residents out of the building for unjust reason. Therefore, the allegation is Unsubstantiated.
Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Shannan Hansen
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)

Page: 2 of 2