045001608-5-10-2021-25-AS-KMKY-C36KK4-20210519075741

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045001608
Report Date: 05/10/2021
Date Signed: 05/10/2021 04:49:09 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
11/17/2020 and conducted by Evaluator Pheej Cheng

COMPLAINT CONTROL NUMBER: 25-AS-20201117150922

FACILITY NAME:	COUNTRY HEARTS		FACILITY NUMBER:	045001608
ADMINISTRATOR:	LEONARD, CAROL		FACILITY TYPE:	740
ADDRESS:	7170 LOWER WYANDOTTE RD.		TELEPHONE:	(530) 589-2466
CITY:	OROVILLE	STATE: CA	ZIP CODE:	95966
CAPACITY:	15	CENSUS: 8	DATE:	05/10/2021
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Carol Leonard; Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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1) Owner / Med Tech is withholding pain medications from resident.
2) Owner is emotionally abusing residents.

INVESTIGATION FINDINGS:

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On 5/10/2021 at 2:30 PM, Licensing Program Analyst (LPA) conducted an unannounced complaint investigations visit via phone and spoke to Administrator Carol Leonard regarding the above allegations. A telephone was made in compliance with the departments COVID-19 procedures.

Continuation on LIC 9099C.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Kevin Mknelly	TELEPHONE: (209) -81-1925
LICENSING EVALUATOR NAME: Pheej Cheng	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2021

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-20201117150922

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: COUNTRY HEARTS	FACILITY NUMBER: 045001608
	VISIT DATE: 05/10/2021

NARRATIVE

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1) Owner / Med Tech is withholding pain medications from resident.

Based on statements and documents obtained, LPA determined the following information. RP was unreachable and resident in question could not be verified. All statements from residents who were able to give responses stated that they are receiving their medications on time and not is not being withheld. PRN medications are administered as needed. A review of the Resident Medication Administration Record indicates that residents are receiving their PRN medication.

2) Owner is emotionally abusing residents.

Based on statements received, LPA determined the following information. All resident statements, with the exception of R2, stated that no such incident has occurred to them nor have they witnessed anything related to the allegation. R2 was interviewed but LPA was unable to obtain any responses. Staff statements show there they have no knowledge of such incidents occurring. Staff statements indicate that most residents are hard of hearing so they would have to increase the volume of their voice along with repeating themselves so that residents can hear and understand. Both staff and resident statements confirm that they are treated with dignity and respect.

This agency has investigated the complaint allegations listed above. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.

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

SUPERVISOR'S NAME: Kevin Mknelly	TELEPHONE: (209) -81-1925
LICENSING EVALUATOR NAME: Pheej Cheng	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2021

LIC9099 (FAS) - (06/04)

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