<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 037001001
Report Date: 08/04/2026
Date Signed: 08/04/2026 04:33:57 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/27/2026 and conducted by Evaluator Kimberly Viarella
COMPLAINT CONTROL NUMBER: 27-AS-20260727164010
FACILITY NAME:GOLD QUARTZ INN RETIREMENT HOMEFACILITY NUMBER:
037001001
ADMINISTRATOR:LOREEN HICKMANFACILITY TYPE:
740
ADDRESS:15 BRYSON DRIVETELEPHONE:
(209) 267-9155
CITY:SUTTER CREEKSTATE: CAZIP CODE:
95685
CAPACITY:47CENSUS: 35DATE:
08/04/2026
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Loreen Hickman, Executive DirectorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not following proper infection control protocols with residents in care.
Facility is not reporting infectious conditions as required.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 08/04/26, Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced visit to this facility to open an investigation into the above allegations. LPA identified herself upon arrival, stated the purpose of the visit, and asked to meet with the Designated Facility Administrator. LPA met with Executive Director (ED) Loreen Hickman and a brief interview followed.

LPA requested the following documents:
Staff roster for all care staff, medication technicians, and housekeeping
Schedules for May, June, and July 2026
Medical reports/test results, and Medication Records for R1 and R2 for June and July 2026

LPA reviewed medical documents for Resident R1. On 05/12/26, a home health nurse reported that R1 had a rash and suspected scabies. The ED stated that the home health nurse reported this information to the doctor and an appointment was made for R1 with a dermatologist on 05/21/26. During that visit,

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2026
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 4
Control Number 27-AS-20260727164010
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: GOLD QUARTZ INN RETIREMENT HOME
FACILITY NUMBER: 037001001
VISIT DATE: 08/04/2026
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
a specific diagnosis was not determined and a biopsy was conducted. LPA reviewed the biopsy report dated 05/21/26 which still did not confirm or rule out a diagnosis of scabies.

LPA reviewed the Electronic Medication Administration Record for R1 and learned the following. R1 was treated with Ivermectin and Permethrin on 05/29/26 and again on 06/05/26.

The ED stated that an incident was not sent to Community Care Licensing (CCL) regarding the possible diagnosis and treatment for scabies. They also stated that although they notified R1's responsible party regarding R1 potentially having scabies. LPA contacted the the responsible party who they were not notified. R1 had been complaining about the rash they had, and their responsible party called to make the appointment with a dermatologist. Home health initially reported their suspicions for R1 potentially having scabies on 05/12/26 and they were not quarantined and kept separate from other residents in care. The ED stated that they thought the home health nurse would contact the family and the PCP so the facility did not. R1 did not receive a medical evaluation until 9 days later on 05/21/26 when the responsible party took R1 due to their complaints regarding their rash. The evaluation was inconclusive and a biopsy was performed. The results remained inconclusive - they neither confirmed nor ruled out scabies. R1 was not quarantined. R1 received treatment 8 days later on 05/29/26 and again on 06/05/26. R1 was quarantined from 05/29/26 until 06/02/26. During that time period, R1 was relocated to another room so their room could be deep cleaned. Although it was not confirmed the rash was from something contagious, it still was a possibility and infection protocols should have been implemented.

According to the California Code of Regulations, Title 22, the facility is responsible for notifying CCL, the resident's primary care physician, and their responsible party whenever there is a change of condition or an unusual incident. Based on a review of records and interviews with the responsible party and the ED, the department found the allegations, "Staff are not following proper infection control protocols with residents in care," and "Facility is not reporting infectious conditions as required," SUBSTANTIATED. These deficiencies have been cited on the LIC 9099D page.

No other deficiencies were observed or cited during today's visit, a copy of this report was provided and an exit interview was conducted with Hickman.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 27-AS-20260727164010
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GOLD QUARTZ INN RETIREMENT HOME
FACILITY NUMBER: 037001001
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/16/2026
Section Cited
CCR
87470
1
2
3
4
5
6
7
CCR 87470 Infection Control

The above regulation was not met as evidenced by:
1
2
3
4
5
6
7
The ED will be bringing in an outside service to conduct an training on infectious diseases/conditions with all staff. ED will send the agenda with the facilitor's contact information and a signature sheet for all participants.
8
9
10
11
12
13
14
Based on a review of medical records and interviews with the ED and the responsible party for R1, the facility was aware of a potentially infectious condition and did not implement infection control protocols. This posed a potential threat to the health, safety and personal rights of residents in care.
8
9
10
11
12
13
14
Type B
08/31/2026
Section Cited
CCR
87211(a)(1)
1
2
3
4
5
6
7
(a) Each licensee shall furnish to the licensing...(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days...specified in (A) through (D) below... The above regulation was not met as evidenced by:
1
2
3
4
5
6
7
ED will have a training on reporting requirements with all staff. ED will send the agenda with the facilitor's contact information and a signature sheet for all participants.
8
9
10
11
12
13
14
Based on interviews with the ED and the responsible party for R1, the facility did not send an LIC 624 to CCL, it did not notify the PCP and it did not contact the resposble party for R1. This posed a potential threat to the health, safety and personal rights of residents in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Lisa Rios
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 27-AS-20260727164010
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GOLD QUARTZ INN RETIREMENT HOME
FACILITY NUMBER: 037001001
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/31/2026
Section Cited
CCR
87465(a)(1)
1
2
3
4
5
6
7
87465 Incidental Medical and Dental Care (a)...shall be developed by each ...(1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents.
The above regulation was not met as evideced by:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
Based on interviews with the ED, the responsible party for R1, and a a review of medical records, the facility waiting 9 days after hone health notified them that R1 might have scabies. This posed a potential threat to the health, safety and personal rights of resdients in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Lisa Rios
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4