045001608-1-5-2024-59-AS-KHOS-CZBQ4Q-20240109105045

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045001608
Report Date: 01/05/2024
Date Signed: 01/05/2024 04:34:44 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
10/18/2023 and conducted by Evaluator Rebecca Knight

COMPLAINT CONTROL NUMBER: 59-AS-20231018093414

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:	11:00 AM
MET WITH:	Natasha Leonard - administrator		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff unlawfully evicting a resident while in care - UNSUBSTANTIATED
Staff does not have adequate record keeping for a resident - UNSUBSTANTIATED

INVESTIGATION FINDINGS:

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01/05/2024 11:00 AM 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 the administrator was interviewed. LPA requested and reviewed the following documents: Staff list with telephone numbers, resident list, Advanced Health Care Directive, letter from responsible party for 1 resident.

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-20231018093414

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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Staff unlawfully evicting a resident while in care - UNSUBSTANTIATED

LPA reviewed a 60-day notice that was sent to all residents and their responsible parties notifying of the impending closure of the facility and the requirement for all residents to move into other accommodations.

Administrator stated they mailed Resident 1’s (R1) responsible party (RP) a 30-day notice for non-payment. Administrator stated they have not received payment (for R1’s care) for the past two months since the administrator took over administrative duties for the facility, that is why the facility sent the 30-day eviction notice.

It was determined that it is not against regulations to serve a client a 30-day eviction notice for non-payment. This allegation is unsubstantiated.

Continued on LIC9099-C

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)

Page: 2 of 3

Control Number 59-AS-20231018093414

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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Staff does not have adequate record keeping for a resident - UNSUBSTANTIATED

It was reported that the RP for R1 has not received the 60-day notice of intent to close the facility from the administrator and both the placement agency and RP have not received the requested LIC602 Physician’s Report from the administrator.

LPA reviewed the 60-day notice of intent to close the facility.

Administrator stated they sent out the 60-day notice of intent to close the facility on 10/19/2023 to all residents and their responsible parties. Administrator stated they sent the LIC602 Physician’s Report to the placement agency on 10/18/2023.

Administrator stated the RP has been asking for medical records. The administrator stated they sent the RP R1’s med list because that is all they have. Administrator stated they advised the RP to contact Enloe Palliative Care for R1’s medical records. Administrator stated they tried to explain to the RP that they do not keep medical records and there have been many phone calls with R1’s RP regarding that.

It was determined the administrator has sent out the 60-day notice of intent to close the facility on 10/19/2023 to all residents and their responsible parties and sent the LIC602 Physician’s Report to the placement agency on 10/18/2023. This allegation is unsubstantiated.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations 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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