045000644-3-25-2025-59-AS-KHOS-DFBHZC-20250401063808

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045000644
Report Date: 03/25/2025
Date Signed: 03/25/2025 11:44:06 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
01/27/2025 and conducted by Evaluator Donna Gurriere

COMPLAINT CONTROL NUMBER: 59-AS-20250127134507

FACILITY NAME:	MARBELLA CHICO		FACILITY NUMBER:	045000644
ADMINISTRATOR:	BLOW, SCOTT		FACILITY TYPE:	740
ADDRESS:	1351 E. LASSEN AVENUE		TELEPHONE:	(530) 899-0814
CITY:	CHICO	STATE: CA	ZIP CODE:	95973
CAPACITY:	79	CENSUS: 61	DATE:	03/25/2025
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	SCOTT BLOW		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff are not providing care regarding a resident’s catheter.
Staff are not providing care when resident is toileting.

INVESTIGATION FINDINGS:

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On 03/25/25 Donna Gurriere and Kayla Adkison, Licensing Program Analysts (LPAs) arrived at the facility unannounced to deliver final findings regarding a complaint that was received on 01/27/25. LPA Gurriere met with Scott Blow and explained the purpose of the visit.

Staff are not providing care regarding a resident’s catheter.

During the interview process, the Resident Care Director and four staff persons were interviewed. The resident (Resident 1) was not interviewed, as he has since moved. Documents were obtained to include Physicians Report, Admission Agreement, Resident Evaluation/Assessment, Individual Program Plan (IPP), Home Health Agency reports and Medical Notes.

continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2025

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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Control Number 59-AS-20250127134507

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MARBELLA CHICO	FACILITY NUMBER: 045000644
	VISIT DATE: 03/25/2025

NARRATIVE

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During the investigation process, staff were interviewed and overall reported that the resident’s needs were being met in several different ways to include providing care regarding the resident’s catheter bag. It was stated that the resident wanted to be independent, and many times did not ask for assistance. Staff reported that the resident was reminded daily to allow staff to assist him. Staff reported that generally the resident’s catheter bag was on the side of his bed or the side of his wheelchair.

Although the above allegation mentioned may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the above findings are Unsubstantiated.

Staff are not providing care when resident is toileting.

During the interview process, the Resident Care Director and four staff persons were interviewed. The resident (Resident 1) was not interviewed, as he has since moved. Documents were obtained to include Physicians Report, Admission Agreement, Resident Evaluation/Assessment, Individual Program Plan (IPP), Home Health Agency reports and Medical Notes.

During the investigation process, staff were interviewed and overall, it was stated that the resident always felt the need to use the toilet and empty his bladder; however, he had to be reminded that he did not need to use the toilet, as that was why he had the catheter bag. Staff advised that the resident was assisted several times throughout the day.

Although the above allegation mentioned may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the above findings are Unsubstantiated.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2025

LIC9099 (FAS) - (06/04)

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