045001608-1-5-2024-59-AS-KHOS-CZBQ8E-20240109105637

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045001608
Report Date: 01/05/2024
Date Signed: 01/05/2024 04:44:19 PM

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
01/02/2024 and conducted by Evaluator Rebecca Knight

COMPLAINT CONTROL NUMBER: 59-AS-20240102104510

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: 2	DATE:	01/05/2024
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Natasha Leonard - administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility is violating resident's personal rights by not allowing her to speak to anyone over the phone.

INVESTIGATION FINDINGS:

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01/05/2023 Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with administrator Natasha Leonard. The purpose of this visit was to deliver the results of a complaint investigation.

During the course of the investigation LPA interviewed the resident, staff and the administrator.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024

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-20240102104510

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: COUNTRY HEARTS	FACILITY NUMBER: 045001608
	VISIT DATE: 01/05/2024

NARRATIVE

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Resident stated they do not receive a lot of calls but when they do receive calls staff hands them the phone to talk to the caller.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are UNSUBSTANTIATED.
An exit interview was conducted. A copy of the report was provided to administrator Natasha Leonard.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024

LIC9099 (FAS) - (06/04)

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