570300654-6-22-2020-21-AS-CMAZ-BQTSQL-20200622140454

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 570300654
Report Date: 06/22/2020
Date Signed: 06/22/2020 12:09:56 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/09/2019 and conducted by Evaluator David Leibert

COMPLAINT CONTROL NUMBER: 21-AS-20191209131041

FACILITY NAME:	ST. JOHN'S RETIREMENT VILLAGE/MANOR		FACILITY NUMBER:	570300654
ADMINISTRATOR:	THERESA J ELY		FACILITY TYPE:	740
ADDRESS:	135 WOODLAND AVENUE		TELEPHONE:	(530) 662-1290
CITY:	WOODLAND	STATE: CA	ZIP CODE:	95695
CAPACITY:	174	CENSUS:	DATE:	06/22/2020
		UNANNOUNCED	TIME BEGAN:	11:08 AM
MET WITH:	Sean Beloud		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Facility staff had inappropriate interactions with residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst Leibert spoke with Administrator Sean Beloud, this date, for the purpose of delivering findings on this complaint. The visit was conducted as a tele - visit due to the COVID - 19 precautions. This Department has investigated the above captioned complaint allegation by conducting site visit; obtaining and reviewing documents; interviewing witnesses and parties. The Allegation is denied. This Department has made the following determinations: S1 admits to giving residents "hugs" and has given residents "rubdowns." S1 denies that the actions herein referred to were sexual in nature and claims that they were meant to be gestures of friendship and nurture towards residents. The Complainant has stated that Complainant does not believe that S1 was inappropriate with residents in a sexual manner. Based upon interviews and statements, the Department has not found evidence that S1's behavior was inappropriate to the degree that it is in conflict with Title Twenty - Two regulations. Although the allegation may be valid, or true, there is not a preponderance of evidence to prove the allegation did, or did not, occur. Therefore, the allegation is UNSUBSTANTIATED.

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: 06/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2020

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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