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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045002440
Report Date: 11/30/2022
Date Signed: 11/30/2022 10:45:22 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 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
10/10/2022 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 25-AS-20221010120453
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: 70DATE:
11/30/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Irene Davis - Executive DirectorTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff not responding to resident’s call button - UNSUBSTANTIATE
Staff are not providing residents with food of good quality - UNSUBSTANTIATE
INVESTIGATION FINDINGS:
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11/302022 9:30 AM Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with Executive Director Irene Davis. 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 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 administrator and nine residents were interviewed. LPA obtained the following documents to investigate the above allegations: Resident list with room numbers, staff list with telephone numbers, menus for the months of September – October 2022, call button logs.

Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2022
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 4
Control Number 25-AS-20221010120453
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: COUNTRY CREST ASSISTED LIVING
FACILITY NUMBER: 045002440
VISIT DATE: 11/30/2022
NARRATIVE
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Page 2

Staff not responding to resident’s call button – UNSUBSTANTIATED

LPA reviewed records of resident call buttons and response times for the date of 9/20/2022. On this date there were 12 call buttons that were pushed 4 to 9 times by the residents and the response time ranged from 17 to 45 minutes. There were an additional 16 call buttons pushed 9 times that received no response on this date. All other call buttons on this date were answered within a reasonable amount of time.

During resident interviews 7 of 9 residents stated when they pressed their call button staff response time was not long to very fast, 1 of 9 residents stated they had never pressed their call button, 1 of 9 residents did not respond to the question.

Administrator stated staff respond in 10 minutes or less, if there is an emergency or when there are a lot of people calling at one time it may take slightly longer for staff to respond. Administrator stated that on 9/20/2022 there were some call buttons that were brought to her attention to which residents had to wait a little while for an answer. When the administrator was notified of this, they worked a night shift on 9/22/2022 which allowed the administrator to observe the way the call system was functioning. Administrator did observe some instances in which residents were waiting too long. Once this was discovered the administrator called Phillips Lifeline and they came to the facility and re-set the call button system to a shorter span of recalls and the system is functioning properly now.

It was determined that the facility call button system was malfunctioning for an unknown period of time based on records review of response times for one date. When administrator discovered this, they immediately called Phillips Lifeline and they re-set the call button system to a shorter span of recalls and the system is functioning properly now and there have been no other issues with the system since. Staff response times are within an acceptable range and residents are not displeased with staff response times when they press their call button. This allegation is unsubstantiated.

Continued on LIC9099-C

SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 25-AS-20221010120453
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: COUNTRY CREST ASSISTED LIVING
FACILITY NUMBER: 045002440
VISIT DATE: 11/30/2022
NARRATIVE
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Page 3

Staff are not providing residents with food of good quality – UNSUBSTANTIATED

LPA reviewed facility menus for the months of September and October 2022. Menus included breakfast, lunch and dinner. All food on the menu seemed appropriate for these mealtimes. In addition to the regular menu items the facility has a breakfast, lunch and dinner menu that offers residents choices that are not included on the daily menu that can be ordered if they so choose.

During resident interviews 7 of 9 residents interviewed stated that the food was alright or OK, 1 resident stated the food was good, 1 of 9 residents stated the food needed help. 2 of 9 residents stated the beef was tough. 5 of 9 residents stated the food was served warm, 3 of 9 residents stated the food was served hot enough, 1 of 9 residents stated the food was served cold.

Administrator stated they hired 2 new cooks recently, but there was a time that the facility only had the food service director and 1 cook. The residents have complained that the meat is tough. The administrator has had cards placed on the dining room tables so the residents can anonymously leave messages about the food.

Administrator stated that some residents complained the food was bland but the facility can’t add salt, because they also prepare meals for the post-acute facility and share a common kitchen and they share the same menu. They can only add ingredients and seasoning after the post-acute meals are delivered.

Continued on LIC9099-C

SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 25-AS-20221010120453
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: COUNTRY CREST ASSISTED LIVING
FACILITY NUMBER: 045002440
VISIT DATE: 11/30/2022
NARRATIVE
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Page 4
Administrator stated the kitchen has to be careful of certain ingredients that may be used. The post-acute facility was issued a citation in January 2022 by California Department of Public Health (CDPH) because the kitchen was not following the recipes to a "T" and were required by CDPH to follow the recipes. That is when the assisted living residents started complaining about the food.

The facility is currently working on getting new menus from the menu company. Administrator stated the dietician at the post-acute facility has to approve them.

It was determined that residents think the food is “OK” but could use some improvement. Due to the fact that the facility shares a common kitchen and menus with the skilled nursing facility they are required to follow the same menu and cannot deviate from that menu. The facility also offers an alternate menu that allows an alternative to the shared menu and more meal choices for the residents. The facility is currently working with the dietician and menu company on developing a new menu for both facilities. 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 facility Executive Director Irene Davis.

SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4