045002440-9-8-2020-25-AS-RLBN-BTHRQK-20200916131340

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045002440
Report Date: 09/08/2020
Date Signed: 09/08/2020 10:28:47 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/22/2020 and conducted by Evaluator Rebecca Knight

COMPLAINT CONTROL NUMBER: 25-AS-20200722151022

FACILITY NAME:	COUNTRY CREST ASSISTED LIVING		FACILITY NUMBER:	045002440
ADMINISTRATOR:	GOBIN-CUELLAR, PATRICIA		FACILITY TYPE:	740
ADDRESS:	55 CONCORDIA LN		TELEPHONE:	(530) 533-7857
CITY:	OROVILLE	STATE: CA	ZIP CODE:	95966
CAPACITY:	150	CENSUS:	DATE:	09/08/2020
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Patricia Gobin-Cuellar		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Resident are given a plunger to unplug their own toilets.
Sewer lines are not working properly.

INVESTIGATION FINDINGS:

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Rebecca Knight, Licensing Program Analyst (LPA) made an unannounced telephone call and spoke with Patricia Gobin-Cuellar, Administrator for the facility. The purpose of this telephone call was to deliver the results of the complaint investigation. The results are being delivered via telephone call due to COVID-19 restrictions.

During the course of the investigation LPA interviewed 6 residents, and 5 facility staff. LPA obtained the following documents: Staff Roster with contact information, Resident Roster with contact information, facility sketch including plumbing configuration and main line sewer hook-up, and service invoices from Thrifty Rooter.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 895-4356
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2020

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-20200722151022

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 COHASETT RD., STE. 170
CHICO, CA 95926

FACILITY NAME: COUNTRY CREST ASSISTED LIVING	FACILITY NUMBER: 045002440
	VISIT DATE: 09/08/2020

NARRATIVE

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Allegation: Resident are given a plunger to unplug their own toilets. - UNSUBSTANTIATED.

During resident interviews 4 of 6 residents stated they had not been given a plunger to keep in their room, 2 of 6 residents stated they bought their own plunger. 5 of 6 residents stated they have not had to plunge their own toilet, 1 of 6 residents stated they try to plunge the toilet themselves and call maintenance if they can’t get it unclogged.

During staff interviews 4 of 5 staff stated that residents have not been given their own plunger, 1 of 5 staff stated they do not know if residents have been given their own plunger. 2 of 5 staff stated the toilets in resident’s rooms do not get clogged, 3 of 5 staff stated the toilet’s in resident’s rooms get clogged every once in a while. 5 of 5 staff stated that residents do not have to plunge their own toilets. 5 of 5 staff stated that disabled residents are not expected to plunge their own toilet.

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.

Allegation: Sewer lines are not working properly. – UNSUBSTANTIATED.

Maintenance staff and facility administrator confirmed that the facility is connected to the public sewer system. LPA’s review of the facility sketch showed the main sewer line is connected to the public sewer system. Maintenance staff stated that facility’s plumbing system has a 6-inch line that goes from the front of the building, from manhole to manhole, from the assisted living facility past the skilled nursing facility to Foothill Blvd. Everything feeds into that 6-inch line to the sewer. LPA reviewed plumbing service invoices for the months of April and May 2020. There was one service call on 4/07/2020, and another service call on 5/05/2020. Both of these calls involved the toilet in room #208 which as plugged with an unknown stoppage, proper flow was regained during these service calls. Two service calls in a span of two months for the same room does not indicate that the sewer lines for the entire facility are not working properly.

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 emailed to facility administrator Patricia Gobin-Cuellar for signature. Administrator agrees to sign, scan and email signed report back to LPA Knight by the end of the business day. No deficiencies were cited on today’s date.

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 895-4356
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2020

LIC9099 (FAS) - (06/04)

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