045002441-2-1-2021-25-AS-RLBN-BXWPZC-20210204104516

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045002441
Report Date: 02/01/2021
Date Signed: 02/01/2021 04:24:27 PM

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
08/27/2020 and conducted by Evaluator Mai Thao

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20200827112213

FACILITY NAME:	AMBER GROVE PLACE		FACILITY NUMBER:	045002441
ADMINISTRATOR:	GREER, ANTHONY		FACILITY TYPE:	740
ADDRESS:	3049 ESPLANADE		TELEPHONE:	(530) 826-3226
CITY:	CHICO	STATE: CA	ZIP CODE:	95973
CAPACITY:	70	CENSUS: 53	DATE:	02/01/2021
		UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Tim Hazen, Managing Director		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff handled resident in a rough manner
Staff yelled at resident
Staff speaks inappropriately in the presence of residents
Insufficient staffing to meet the needs of the residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mai Thao called the facility unannounced on today’s date and spoke with Tim Hazen, Managing Director. LPA explained purpose of call is to delivered findings for the above allegations. LPA explained the reason a physical visit cannot be completed for this visit was due to COVID-19.

LPA delivered findings on today’s date.

(Continue 9099-C…)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Mai Thao	TELEPHONE: (530) 895-5805
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2021

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-20200827112213

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: AMBER GROVE PLACE	FACILITY NUMBER: 045002441
	VISIT DATE: 02/01/2021

NARRATIVE

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Staff handled resident in a rough manner
Licensing Program Analyst (LPA) interviewed 5 residents, majority of the residents stated that staff are nice and assist them with care. LPA interviewed 7 staff members who stated that resident have not been injured while in care. Staff stated in interviews that staff have not witness resident being handled roughly. Managing Director, Tim Hazen also confirms this in interview that there has been no incident or injury reported due to staff handling resident roughly. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Staff yelled at resident
Licensing Program Analyst (LPA) interviewed 5 residents, majority of residents stated that the staff are nice and assist them with care. LPA interviewed 7 staff members who stated that staff do not yell at residents. Staff stated in interviews that sometimes staff will have to talk in a louder tone of voice because some residents are hard of hearing, but never yelling at the residents. Managing Director, Tim Hazen stated in interviews that staff are trained on how to talk and assist with residents with Dementia and this behavior is intolerable. Tim also confirms in interview that this has never happened. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

(continue 9099-C....)

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Mai Thao	TELEPHONE: (530) 895-5805
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 25-AS-20200827112213

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: AMBER GROVE PLACE	FACILITY NUMBER: 045002441
	VISIT DATE: 02/01/2021

NARRATIVE

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Staff speaks inappropriately in the presence of residents
It was alleged that staff are cussing and sharing personal information in the presence of residents. LPA interview 5 residents who were not able to comment if this happens or not. LPA interview 7 staff members who stated that staff does not cuss around residents or at work. Staff stated that if staff hear another staff cussing, it will be reported to management, but this has not happened. Staff stated that they were trained to come to work, leave their personal matter at home, and not bring it to work. Managing Director, Tim Hazen stated in interviews that the facility has a zero-tolerance policy and provided LPA with copy. Tim stated that all staff members are provided one during orientation and signed that they read and agree. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Insufficient staffing to meet the needs of the residents
It was alleged that the staff scheduled each shift were out of compliance. Licensing Program Analyst (LPA) Mai Thao interviewed 5 residents in which majority states that staff are nice and assist them with their Activities of Daily Living (ADL) with no problem. LPA interviewed 7 staff who states that staff assist residents with their ADL. Staff stated in interviews that at times it does get busy, but all staff are able to assist the residents with no problem. Staff stated that sometimes some ADLs, such as bathing/shower, is not completed because resident refuse, not due to staff. Staff interviewed stated that residents’ needs are being met. Managing Director, Tim Hazen, stated that residents’ needs are being met. Tim also stated that there are 2 managers who are always on the floor who can help assist with care if the staff are busy assisting other residents. Tim also stated that the facility has on-call staff who are able to come cover shift if another staff calls off. Tim stated that the facility does not have staffing concerns. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

(continue 9099-C...)

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Mai Thao	TELEPHONE: (530) 895-5805
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 25-AS-20200827112213

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: AMBER GROVE PLACE	FACILITY NUMBER: 045002441
	VISIT DATE: 02/01/2021

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	No citations were observed during this complaint investigation. An exit interview was conducted. Appeal rights and Two (2) copies of this report was mailed via United States Postal Services (USPS) and email to Tim Hazen, Managing Director. One copy is to sign and return to LPA to put on file and one to keep at the facility.

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Mai Thao	TELEPHONE: (530) 895-5805
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 4