<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045002440
Report Date: 09/19/2023
Date Signed: 09/19/2023 11:36:20 AM

Substantiated


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
08/01/2023 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 59-AS-20230801152812
FACILITY NAME:COUNTRY CREST ASSISTED LIVINGFACILITY NUMBER:
045002440
ADMINISTRATOR:DAVIS, IRENEFACILITY TYPE:
740
ADDRESS:55 CONCORDIA LNTELEPHONE:
(530) 533-7857
CITY:OROVILLESTATE: CAZIP CODE:
95966
CAPACITY:150CENSUS: 67DATE:
09/19/2023
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Desirea Rodas - Business Office ManagerTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not keeping facility at a comfortable temperature - SUBSTANTIATED
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
09/19/2023 1:30 PM Licensing Program Analyst (LPA) Rebecca Knight made an unannounced visit to the facility and met with administrator Irene Davis. The purpose of this visit was to deliver the results of a complaint investigation.

During the course of the investigation the administrator, 3 staff, and 2 residents were interviewed.

The following documents were received and reviewed: Resident list with room numbers, staff list with telephone numbers, Emergency Disaster drill log, air conditioning repair and replacement invoices.

Continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
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 59-AS-20230801152812
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 CREST ASSISTED LIVING
FACILITY NUMBER: 045002440
VISIT DATE: 09/19/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Page 2

Staff are not keeping facility at a comfortable temperature. - SUBSTANTIATED

It was reported that the 2nd and 3rd floors of the facility are hot and not a comfortable temperature.

On the day of LPA visit 08/09/2023 The Weather Channel website recorded a high temperature of 93 degrees F in Oroville CA. LPA measured room temperature in dining room (second floor) at 77 degrees F. LPA measured room temperature in activity room (third floor) at 77 degrees F. LPA observed that new air conditioning ceiling units had been installed in the kitchen and anteroom just outside of the kitchen. These units were non-operational at the time of the visit but an installation / repair crew was on site trouble shooting an issue with the units leaking after installation. LPA observed air conditioning window unit installed and operating in dining room window and a large swamp cooler was operating in the kitchen.



LPA reviewed a quote from Grimes Heating and Air Conditioning dated 08/08/2023 which reflected the price for purchase and installation of two Seer Heat Pump Split Systems.

During staff interviews it was learned that the facility was in the process of replacing air conditioning units in the kitchen. The dining room temperature is connected to the two air conditioners that were replaced in the kitchen. Prior to that the facility had two window a/c units in the dining room and installed swamp coolers and portable air conditioning units in the kitchen.

Resident interviews revealed that the facility put in a new air conditioner in the dining room and kitchen, and it took a long time to replace the air conditioning units in the kitchen.

Continued on LIC9099-C

SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 59-AS-20230801152812
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 CREST ASSISTED LIVING
FACILITY NUMBER: 045002440
VISIT DATE: 09/19/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Page 3
Administrator stated At the end of Summer (2022) there was one unit working in the kitchen and by Summer 2023 both units were shut down. Administrator stated they did submit for the units to be replaced but it took a while for corporate to approve. When it got hot we purchased portable AC units and we rented some bigger units, we had a company come out here and do it. The work to replace the units with new units was started on 08/03/2023 and completed on 08/04/2023. They started gathering water and Grimes came out 8/5/2023 through 8/8/2023 to repair the leak. The work was completed and the units were ready to run on 8/9/2023.

It was determined that although staff made reasonable efforts to keep the temperature comfortable for the residents when the weather became hot, the licensee did not complete repair or replacement of the non-operating air conditioning units in a reasonable amount of time. The licensee was aware that the air conditioning units were in need of repair / replacement in Summer 2022 and did not replace or repair the units until Summer 2023. This is an unreasonable amount of time to wait to replace broken air conditioning units particularly considering the average temperatures of the geographic area that the facility is located in. This allegation is substantiated.

Based on interviews and evidence obtained during the investigation, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22), is being cited on the attached LIC9099D. Failure to correct the deficiencies may also result in civil penalties. Appeal rights were provided. Exit interview was conducted and the report was provided to Desirea Rodas - Business Office Manager and administrator Irene Davis.

SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 59-AS-20230801152812
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 CREST ASSISTED LIVING
FACILITY NUMBER: 045002440
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/03/2023
Section Cited
CCR
87303(b)(2)
1
2
3
4
5
6
7
87303(b)(2) Maintenance and Operation - (b) A comfortable temperature for residents shall be maintained at all times. (2) The facility shall cool rooms to a comfortable range, between 78 degrees F (26 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat to 30 degrees F less than the outside temperature. This requirement is not met as evidenced by:
1
2
3
4
5
6
7
The facility replaced the non-functioning air conditioning units in the kitchen and anteroom to the kitchen and completed the trouble shooting of the new units. The installation and repair is complete.
8
9
10
11
12
13
14
Based on observation, interviews, and records review it was determined that the licensee was aware that the air conditioning units were in need of repair / replacement in Summer 2022 and did not replace or repair the units until Summer 2023 which poses a potential health and safety risk to residents in care.
8
9
10
11
12
13
14
LPA Knight toured the facility during the visit and confirmed that the air conditioning units were functioning properly. This POC is complete.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
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
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
08/01/2023 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 59-AS-20230801152812

FACILITY NAME:COUNTRY CREST ASSISTED LIVINGFACILITY NUMBER:
045002440
ADMINISTRATOR:DAVIS, IRENEFACILITY TYPE:
740
ADDRESS:55 CONCORDIA LNTELEPHONE:
(530) 533-7857
CITY:OROVILLESTATE: CAZIP CODE:
95966
CAPACITY:150CENSUS: 67DATE:
09/19/2023
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Irene Davis - Executive DirectorTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not conducting fire drills regularly - UNSUBSTANTIATED
Staff are not meeting resident's needs due to a lack of staffing - UNSUBSTANTIATED
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
09/19/2023 11:15 AM Licensing Program Analyst (LPA) Rebecca Knight made an unannounced visit to the facility and met with administrator Irene Davis. The purpose of this visit was to deliver the results of a complaint investigation.

During the course of the investigation the administrator, 3 staff, and 2 residents were interviewed.

The following documents were received and reviewed: Resident list with room numbers, staff list with telephone numbers, Emergency Disaster drill log, air conditioning repair and replacement invoices.

Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
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 59-AS-20230801152812
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 CREST ASSISTED LIVING
FACILITY NUMBER: 045002440
VISIT DATE: 09/19/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
 Page 2

Staff are not conducting fire drills regularly. - UNSUBSTANTIATED

It was reported that the facility has not been conducting regular fire drills, residents have never had a fire drill or been told what do when the fire alarm goes off

LPA reviewed a log of emergency drills which documented that emergency drills were conducted monthly in May through August 2022, December 2022 and January 2023. The next drill was not logged until June 27, 2023.

3 of 3 staff stated that there was an accidental fire alarm pull. 1 staff stated the facility does 3 fire drills each year and other emergency drills.

1 of 2 residents stated not too long ago for some reason the fire alarms were going off. 1 of 2 residents stated they have been included in a fire drill at the facility.

Administrator stated While I was on vacation a staff member accidentally pulled the fire alarm. It upset the residents, we have new residents who had not been involved in a fire drill before. It was in the middle of the night and there was no warning. When we do fire drills we let the residents know that we were doing them and explain the process to them and ask them to stay where they are during the drill because the fire doors close and if we know what time we are doing it we will make sure they are not in the elevator. When they come and test the systems we do a thorough drill . We did it every six months.

It was determined that even though the facility did not conduct an emergency evacuation drill for four months during the period of February 2023 through May 2023 previous to this gap they had been conducting fire drills monthly, per regulations emergency disaster drill are to be conducted quarterly. Per regulations it is not a requirement for residents to be included in fire drills, the administrator should make residents aware of their role when an emergency disaster drill is conducted or a fire alarm is activated. This allegation is unsubstantiated.

Continued on LIC9099-C

SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 59-AS-20230801152812
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 CREST ASSISTED LIVING
FACILITY NUMBER: 045002440
VISIT DATE: 09/19/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Page 3
Staff are not meeting resident's needs due to a lack of staffing. - UNSUBSTANTIATED

It was reported that there are residents who must wheel themselves back to their room or to the dining room because there are no staff around to help them, and residents had to wait an extended amount of time for dinner due to a lack of staff.

During staff interviews it was learned that the care givers check on residents and will take them back to their room. Care staff do not wait in the dining room to transport residents back to their rooms, the dining room servers will page the care giver and they will come assist the resident back to their room. It might take an extra minute for transport.

1 of 3 staff stated there was an issue with 1 cook who was unable to prepare meals timely but they replaced them with another cook. 1 of 3 staff stated they were a bit short staffed and when they get a call off they try to cover. 1 of 3 staff stated they felt like there could be at least one extra person but they are usually pretty staffed.

1 of 2 residents stated If the facility is short on staff they will call some of the other staff and they come in. 1 of 2 residents stated there seems to be the right amount of staff. 1 of 2 residents stated they did not think they waited quite an hour and now that they have the 2 servers at night it helps. 1 of 2 residents stated they typically wait about 15 minutes for their meals.

Administrator stated Yes there are enough staff. We got staff challenged but it should not be happening now. I walk around and there are a few residents who don’t like to wait and me and my managers will take them if we see that happening. There was the one cook who did not have good time management skills and we moved them to other duties. When I got back (from vacation) I heard they had to wait about 45 minutes and that shouldn’t happen.

It was determined that even though there was one incident where residents had to wait an extended period of time for their meal overall the facility prepares and serves meals in an acceptable amount if time. Care staff are available to transport residents back to their rooms and do so when paged by dining room staff. 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 Desirea Rodas - Business Office Manager and administrator Irene Davis.

SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
LIC9099 (FAS) - (06/04)
Page: 7 of 7