045000700-3-12-2021-25-AS-RLBN-BZGUSU-20210326155052

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045000700
Report Date: 03/12/2021
Date Signed: 03/12/2021 03:08:44 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/21/2020 and conducted by Evaluator Pheej Cheng

COMPLAINT CONTROL NUMBER: 25-AS-20200921121635

FACILITY NAME:	COURTYARD AT LITTLE CHICO CREEK, THE		FACILITY NUMBER:	045000700
ADMINISTRATOR:	MORALES, MELISSA		FACILITY TYPE:	740
ADDRESS:	1770 HUMBOLDT ROAD		TELEPHONE:	(530) 342-0707
CITY:	CHICO	STATE: CA	ZIP CODE:	95928
CAPACITY:	49	CENSUS: 27	DATE:	03/12/2021
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Melissa Morales; Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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1) Resident's room is cold. Facility placed a lock box on thermostat.
2) Residents belongings are missing.
3) Facility food has too much sodium and is unhealthy.

INVESTIGATION FINDINGS:

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On 3/12/21 at 1:30 PM, Licensing Program Analyst (LPA) Cheng conducted a complaint investigations visit via telephone and spoke to Administrator Melissa Morales. A telephone call was made in compliance with the department's procedures regarding COVID. LPA delivered the findings for the above allegations.

Continuation on LIC 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Pheej Cheng	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2021

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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Control Number 25-AS-20200921121635

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: COURTYARD AT LITTLE CHICO CREEK, THE	FACILITY NUMBER: 045000700
	VISIT DATE: 03/12/2021

NARRATIVE

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1) Resident's room is cold. Facility placed a lock box on thermostat.

Based on statements and documents obtained, LPA determined that there is insufficient information available. R1 states that a lock box was placed in R1's room to prevent R1 from adjusting the temperature; however facility staff states that the lock box was installed for the safety of R1 and at R1's request. Both facility staff and R1 confirmed that R1 likes the room hot; which can be be unsafe as R1 tends to layer up in clothing. Facility stated that the lock box has been removed. This was confirmed by R1.

2) Residents belongings are missing.

Based on statements and documents obtained, LPA determined that there is insufficient information available. R1 states that her belongings have been missing; which includes shampoo, jewelry, and other miscellaneous items. Facility states that R1's room requires frequent cleaning as R1 has a behavior of excessive collection of items. Facility provided picture proof. Staff states that staff ask for permission/consent for the removal of R1's items prior to being thrown away. Also, all removal of R1's items are done in the presence of R1. R1's LIC 621 does not list any personal items.

3) Facility food has too much sodium and is unhealthy.

Based on statements and documents obtained, LPA determined that there is insufficient information available. R1 states that R1 has a special diet set by her primary physician; however, there's no indication on that in her LIC 602. Staff statements indicate that alternate food options are available at the request of the residents.

Continuation on LIC 9099C.

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Pheej Cheng	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2021

LIC9099 (FAS) - (06/04)

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Control Number 25-AS-20200921121635

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: COURTYARD AT LITTLE CHICO CREEK, THE	FACILITY NUMBER: 045000700
	VISIT DATE: 03/12/2021

NARRATIVE

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Based upon the information obtained during investigation. The above allegations are unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

No deficiency cited.

Exit interview conducted. Two copies of report was given and LPA requested for a signed return copy.

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Pheej Cheng	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2021

LIC9099 (FAS) - (06/04)

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