045002441-4-23-2024-59-AS-LMUZ-D59PJD-20240514112122

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045002441
Report Date: 04/23/2024
Date Signed: 04/23/2024 08:32:36 AM

Unfounded

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
02/29/2024 and conducted by Evaluator Jaynae Boyles

COMPLAINT CONTROL NUMBER: 59-AS-20240229113634

FACILITY NAME:	AMBER GROVE PLACE		FACILITY NUMBER:	045002441
ADMINISTRATOR:	REITZ, BRENDA		FACILITY TYPE:	740
ADDRESS:	3049 ESPLANADE		TELEPHONE:	(530) 826-3226
CITY:	CHICO	STATE: CA	ZIP CODE:	95973
CAPACITY:	70	CENSUS: 62	DATE:	04/23/2024
		UNANNOUNCED	TIME BEGAN:	08:05 AM
MET WITH:	Clinical Services Director- Lori Whitburn		TIME COMPLETED:	08:35 AM

ALLEGATION(S):

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Staff does not monitor resident's change of health.
Staff does not ensure resident is adequate fed resulting in resident losing weight.
Staff do not ensure resident's grooming needs are being met.
Staff do not provide adequate supervision to resident in care.

INVESTIGATION FINDINGS:

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On 04/23/2024 Licensing Program Analyst Jaynae Boyles made an unannounced visit to the facility and met with Clinical Services Director. The purpose of this visit was to deliver the results of a complaint investigation. During the course of the investigation the administrator, resident, four witnesses and three staff were interviewed. LPA reviewed the following documents: Resident file, visitation log and the staff schedule for the facility.

This agency has investigated the complaint alleging Staff does not monitor resident's change of health, Staff does not ensure resident is adequate fed resulting in resident losing weight, Staff do not ensure resident's grooming needs are being met, Staff do not provide adequate supervision to resident in care.
We have found the complaint was UNFOUNDED, meaning that the allegation is false, could not have happened, and/or is without a reasonable basis.

An exit interview was conducted. A copy of the report was provided to staff.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Jaynae Boyles	TELEPHONE: (916) 208-6251
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

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 59-AS-20240229113634

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: AMBER GROVE PLACE	FACILITY NUMBER: 045002441
	VISIT DATE: 04/23/2024

NARRATIVE

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LPA investigated, “Staff does not monitor resident's change of health”. All witnesses and staff have stated that there has been no change of condition for the resident since the onset of placement within the facility.
LPA investigated, “Staff does not ensure resident is adequate fed resulting in resident losing weight”. All witnesses and staff reported that the resident has not lost any weight since placement within the facility.
LPA investigated, “Staff do not ensure resident's grooming needs are being met”. All witness and staff have reported that the residents grooming needs are met by the resident or the facility staff. Family reported that at the onset of placement in the facility the resident was having difficulty saving and the family purchased an electronic shaver for the resident.
LPA investigated, “Staff do not provide adequate supervision to resident in care”. All witness report that the resident is receiving adequate supervision at the facility. The staff report that the resident receives assistance when requested.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Jaynae Boyles	TELEPHONE: (916) 208-6251
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

LIC9099 (FAS) - (06/04)

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