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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045001608
Report Date: 07/27/2022
Date Signed: 07/27/2022 10:42:04 AM

Substantiated


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
02/11/2022 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 25-AS-20220211133457
FACILITY NAME:COUNTRY HEARTSFACILITY NUMBER:
045001608
ADMINISTRATOR:LEONARD, CAROLFACILITY TYPE:
740
ADDRESS:7170 LOWER WYANDOTTE RD.TELEPHONE:
(530) 589-2466
CITY:OROVILLESTATE: CAZIP CODE:
95966
CAPACITY:15CENSUS: 8DATE:
07/27/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Carol Leonard - LicenseeTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Facility is in disrepair – SUBSTANTIATED
Multiple areas of potential hazard are accessible to residents - SUBSTANTIATED
INVESTIGATION FINDINGS:
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07/27/2022 9:00 AM Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with licensee Carol Leonard. The purpose of this visit was to deliver the results of the complaint investigation of the above allegations. Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask, gloves. In addition, LPA was screened by facility staff.

During the course of the investigation LPA interviewed the licensee and staff. LPA obtained the following documents to investigate the above allegations: Staff roster with telephone numbers, resident roster, facility map, admission agreement, and house rules.

Continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 895-4356
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 7
Control Number 25-AS-20220211133457
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: 07/27/2022
NARRATIVE
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Facility is in disrepair – SUBSTANTIATED

During LPA’s tour of the facility on 7/15/2022 the following were observed: Wooden deck located on the southeast side of the facility is in disrepair with open areas in the flooring area and no handrail accessible to residents, interior hallway walls have areas that have been patched but are unpainted, exterior clutter to include construction materials and debris (wood, hoses, discarded pvc pipe), horse trailer containing refuse (plastic chairs, cardboard boxes etc.) parked in the rear of the facility on the east side.

Staff stated that the porch that is located at the back of the facility is a safety issue but staff watch the residents. Staff stated that residents have access to the porch.

Licensee stated they are working on the back porch and decking, and the fence in front is almost done. Licensee stated that one resident has a slider that accesses the back porch, the resident does not go out there but their responsible party visits them through the slider.

Licensee stated the facility has garbage service pickup each week. There was one staff that was new and she was putting garbage in the horse trailer but licensee told her to not do that and cleaned it up immediately. This is not an ongoing issue.

Continued on LIC9099-C

SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 895-4356
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 25-AS-20220211133457
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: 07/27/2022
NARRATIVE
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Multiple areas of potential hazard are accessible to residents – SUBSTANTIATED

During LPA’s tour of the facility on 7/15/2022 the following were observed: Wooden deck located on the southeast side of the facility in disrepair with open areas in the flooring area and no hand rail accessible to residents, unplugged refrigerator observed outside near the east entrance to the T.V./Recreation/Dining room with doors still intact and rotting food inside accessible to residents, orange electrical cord extended over a walkway located on the west side of the facility which protrudes from a pipe on the ground on one end and appears to lead to an electric driveway gate.

Staff stated that the porch that is located at the back of the facility is a safety issue but staff watch the residents. Staff stated that residents have access to the porch.

Licensee stated they are working on the back porch and decking, and the fence in front is almost done. Licensee stated that one resident has a slider that accesses the back porch, the resident does not go out there but their responsible party visits them through the slider.

Based on interviews and evidence obtained during the investigation, the preponderance of evidence standard has been met, therefore, the above allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22), is being cited on the attached LIC9099D. Appeal rights were provided. Exit interview was conducted and the report was emailed to licensee Carol Leonard.

SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 895-4356
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 25-AS-20220211133457
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/24/2022
Section Cited
CCR
87303(a)
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87303(a) Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:
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Licensee agrees to obtain completion date of repair of rear porch/deck and addition of handrails.. This area is to be made inaccessible to residents until the repair has been completed and approved by Licensing. Licensee to provide LPA with written estimated date of completion. Licensee is to paint hallways that currently have patching materials on them. Licensee is to remove all garbage and clutter from facility grounds including the contents of the horse trailer and the dilapidated refrigerator. Once repairs have been completed Licensee is to send photographs and any repair invoices to LPA as proof of correction.
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Based on LPA observation the facility has a wooden deck which is in disrepair with open areas in the flooring and no hand rail, interior hallway walls have areas that have been patched but are unpainted, there is exterior clutter to include construction materials and debris, a horse trailer containing refuse parked in the rear of the facility, and an unplugged refrigerator is located outside with doors still intact and rotting food inside accessible to residents which poses a potential health and safety risk to residents in care.
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The proof of correction is to be received by LPA Knight by 8/24/2022.
Type B
08/24/2022
Section Cited
CCR
87307(d)(2)
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87307(d)(2) Personal Accommodations and Services (d) The following space and safety provisions shall apply to all facilities: (2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. This requirement is not met as evidenced by:
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Licensee agrees to abate the trip hazzard of the orange electrical cord that is protruding from a pipe on the ground and is extended over a walkway. Once repairs have been completed Licensee is to send photographs and any repair invoices to LPA as proof of correction.
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Based on LPA observation there is an orange electrical cord extended over a walkway which protrudes from a pipe on the ground on one end one and appears to lead to an electric driveway gate which poses a potential health and safety risk to residents in care.
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The proof of correction is to be received by LPA Knight by 8/24/2022.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 895-4356
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 7
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
02/11/2022 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 25-AS-20220211133457

FACILITY NAME:COUNTRY HEARTSFACILITY NUMBER:
045001608
ADMINISTRATOR:LEONARD, CAROLFACILITY TYPE:
740
ADDRESS:7170 LOWER WYANDOTTE RD.TELEPHONE:
(530) 589-2466
CITY:OROVILLESTATE: CAZIP CODE:
95966
CAPACITY:15CENSUS: 8DATE:
07/27/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Carol Leonard - LicenseeTIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
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5
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9
Facility is not sanitary – UNSUBSTANTIATED
Solid waste is not being disposed of properly – UNSUBSTANTIATED
Staff are using e-cigarettes inside the facility and exposing residents to second-hand fumes – UNSUBSTANTIATED
INVESTIGATION FINDINGS:
1
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3
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5
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07/27/2022 9:00 AM Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with licensee Carol Leonard. The purpose of this visit was to deliver the results of the complaint investigation of the above allegations. Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 Mask, gloves. In addition, LPA was screened by facility staff.
During the course of the investigation LPA interviewed the licensee and staff. LPA obtained the following documents to investigate the above allegations: Staff roster with telephone numbers, resident roster, facility map, admission agreement, and house rules.
Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 895-4356
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 25-AS-20220211133457
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: 07/27/2022
NARRATIVE
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Facility is not sanitary – UNSUBSTANTIATED

LPA observed the interior of the facility to be clean and sanitary. No odors were observed while inspecting the exterior of the facility that would indicate unsanitary conditions.

Staff interviews revealed that the facility has one big trash can out front where all household garbage is disposed of, and the facility has garbage service.

Licensee stated the facility has a garbage service pickup each week. Some time ago there was one new staff who was putting garbage in the horse trailer but the licensee told the staff not do that and cleaned it up immediately.

Solid waste is not being disposed of properly – UNSUBSTANTIATED

LPA observed a large trash can in front of the facility that is used to dispose of household waste. No solid waste was observed outside of this container. There is a horse trailer parked in the back that contained debris but no solid waste or odors were observed.

Staff interviews revealed that the facility has one big trash can out front where all household garbage is disposed of, and the facility has garbage service.

Licensee stated the facility has a garbage service pickup each week. Some time ago there was one new staff who was putting garbage in the horse trailer but the licensee told the staff not do that and cleaned it up immediately.

Continued on LIC9099-C

SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 895-4356
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 25-AS-20220211133457
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: 07/27/2022
NARRATIVE
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Staff are using e-cigarettes inside the facility and exposing residents to second-hand fumes – UNSUBSTANTIATED

LPA review of the facility’s house rules revealed that there is no smoking allowed by employees or residents except in the designated area outside.

Staff stated they have never seen anyone smoking or vaping inside of the facility, staff have been made aware that smoking and vaping are not allowed inside of the facility and staff are aware of the location of the designated smoking/vaping section at the facility.

Licensee stated staff are not allowed to smoke or vape inside the facility, there is a designated smoking/vaping section for staff and staff know exactly where this section is located.

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 emailed to facility licensee Carol Leonard.

SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 895-4356
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2022
LIC9099 (FAS) - (06/04)
Page: 7 of 7