570316115-7-20-2021-21-AS-KMOA-C5CM5Y-20210728091906

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 570316115
Report Date: 07/20/2021
Date Signed: 07/20/2021 03:31:13 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, 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
04/02/2021 and conducted by Evaluator Christopher Arnhold

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20210402163604

FACILITY NAME:	CALIFORNIAN, THE		FACILITY NUMBER:	570316115
ADMINISTRATOR:	KATHY B. NEESER		FACILITY TYPE:	740
ADDRESS:	1224 COTTONWOOD STREET		TELEPHONE:	(530) 666-2433
CITY:	WOODLAND	STATE: CA	ZIP CODE:	95695
CAPACITY:	130	CENSUS: 83	DATE:	07/20/2021
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Kathy Neeser		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident's needs are not being met.

INVESTIGATION FINDINGS:

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

At approximately 10:45AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility to complete an investigation into the above allegation. LPA met with Administrator Kathy Neeser, interviewed staff and reviewed records. LPA conducted interviews with S1 and S2. Based on interviews, R1 did not want to take part in the activities of the facility. R1 would stay in their room. R1 was not at the facility long and was admitted to Hospice shortly after coming to the facility. Based on a record review and interviews conducted, facility followed regulation in regards to R1.

Although the allegation 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 allegation is Unsubstantiated.
No citations issued.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021

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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