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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045002441
Report Date: 12/15/2022
Date Signed: 12/15/2022 12:18:57 PM

Substantiated


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
07/25/2022 and conducted by Evaluator Kevin Mknelly
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20220725140624
FACILITY NAME:AMBER GROVE PLACEFACILITY NUMBER:
045002441
ADMINISTRATOR:CROWLEY, JOHNFACILITY TYPE:
740
ADDRESS:3049 ESPLANADETELEPHONE:
(530) 826-3226
CITY:CHICOSTATE: CAZIP CODE:
95973
CAPACITY:70CENSUS: DATE:
12/15/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:John CrowleyTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Residents not accorded dignity in relationships with staff
Facility staff recording residents without permission
Facility staff are not wearing masks as required
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 12/15/22 to deliver complaint findings. LPA met with Executive Director, John Crowley and explained the purpose of the visit. Prior to initiating the complaint visit, LPA completed required Department COVID-19 protocols. LPA completed a facility risk assessment upon arrival. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA was screened by facility staff upon entering the facility.

The department reviewed client/resident records, facility records and conducted extensive interviews.
The department finds that the allegations cited above are substantiated.

Video recordings, photos and statements showed that S1-S10 participated in a “private” group SnapChat where photos and or videos were shared among the group of staff of R1- R10. In some of the video residents with dementia were being laughed at or their disabilities recorded in a way that was not affording them dignity and would have been humiliating.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
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 8
Control Number 25-AS-20220725140624
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: 12/15/2022
NARRATIVE
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Video recordings, photos and statements showed that S1-S10 participated in a “private” group SnapChat where photos and or videos were shared among the group of staff of R1- R10. Residents and their responsible parties were not afforded privacy whereby informed consent was not given for the photos to be shared.

When informed of the occurrence when the complaint was opened, the Director took appropriate actions to stop the use of the photo site, took disciplinary actions as appropriate with those staff involved and provided staff training to all staff regarding resident rights and program policies.

During the Director’s investigation, S6 stated to the Director that S6 would not always wear their required surgical mask in violation of State guidelines and program policy.

The facility reviewed and modified their staff sign in procedures to reinforce the policy requiring use of masks.

As a result of this investigation, LPA finds allegation to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. (A)This poses an immediate Health and Safety risk to clients/residents in care. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care.

Report reviewed with . Copy of this report and appeal rights provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 8
Control Number 25-AS-20220725140624
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/15/2022
Section Cited
CCR
87468.1(a)(2)
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Personal Rights of Residents in All Facilities. Residents …shall have all of the following personal rights: (2) To be free from … humiliation, … This requirement was not met based on statements and photo/video evidence that staff S1-S10 took photos and videos
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This violation has been corrected during the course of the investigation.
When informed of the occurrence when the complaint was opened, the Director took appropriate actions to stop the use of the photo site, took disciplinary actions as appropriate with those staff involved
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of residents that were shared on a staff group SnapChat site. In several of the videos staff could be heard laughing at residents who demonstrated deficits or behaviors due to their dementia disabilities. This posed an immediate risk to resident personal rights.
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and provided staff training to all staff regarding resident rights and program policies.
Type A
12/15/2022
Section Cited
CCR
87468.2(a)(1)
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Additional Personal Rights of Residents in Privately Operated Facilities
(a) In addition to the rights listed in Section 87468.1,…residents…have all of the following personal rights: (1) To have a reasonable level of personal privacy in accommodations... This
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This violation has been corrected during the course of the investigation.
When informed of the occurrence when the complaint was opened, the Director took appropriate actions to stop the use of the photo site, took disciplinary actions as appropriate with those staff involved
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requirement was not met based on statements and photo/video evidence that staff S1-S10 took photos and videos of residents that were shared on a staff group SnapChat site. This posed an immediate risk to resident personal rights.
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and provided staff training to all staff regarding resident rights and program policies.
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: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 8
Control Number 25-AS-20220725140624
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/05/2023
Section Cited
CCR
87468.1(a)(2)
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Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This
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The facility reviewed and modified their staff sign in procedures to reinforce the policy requiring use of masks.
Licensee will submit the updated sign in procedures that will include a person screening staff upon entry instead of self assessment and contain a method of
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requirement was not met.
Based on S6 statement to the Administrator on 7/31/22, licensee and/or administrator/facility Manager did not ensure the personal rights of persons in care to safe and healthful accommodations, S6 stated to the Administrator that they “had their mask down; some times it’s hard to breath w/ them on.” This posed a potential risk to residents.
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reminding staff about masking requirements.
Due by the POC date of 1/5/22.
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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: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 8
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
07/25/2022 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 25-AS-20220725140624

FACILITY NAME:AMBER GROVE PLACEFACILITY NUMBER:
045002441
ADMINISTRATOR:CROWLEY, JOHNFACILITY TYPE:
740
ADDRESS:3049 ESPLANADETELEPHONE:
(530) 826-3226
CITY:CHICOSTATE: CAZIP CODE:
95973
CAPACITY:70CENSUS: DATE:
12/15/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:John CrowleyTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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9
Staff not assisting residents with ADLs as needed
Facility flores are not cleaned and disinfected on a regular basis
Staff do not ensure that residents have clean linens
Administrator qualifications- lack of management oversight over staff at the facility
Appropriate hands-on training not provided to staff
Facility personnel not sufficient in number at all times to meet the needs of residents
Call button not working in resident rooms
Resident at risk was allowed direct access to personal grooming and hygiene items
Locks on resident cabinets are broken
Food is not of the quality or quantity necessary to meet the needs of residents
INVESTIGATION FINDINGS:
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On 12/15/22, Licensing Program Analyst (LPA) Kevin Mknelly conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met with clinical staff. Prior to initiating the complaint visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Upon arrival, completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA was screened with temperature at the facility and symptom screen.

LPAs conducted records review and extensive interviews.
Residents with limited recall of historic events were not able to provide substantial statements.
LPA is unable to find and or meet the preponderance, per policy.
Staff not assisting residents with ADLs as needed- Records reviewed and statements provided did not provided evidence to support this allegation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
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 8
Control Number 25-AS-20220725140624
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: 12/15/2022
NARRATIVE
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Facility floors are not cleaned and disinfected on a regular basis- Records reviewed, facility inspections and statements provided did not provided evidence to support this allegation.
Staff do not ensure that residents have clean linens- Records reviewed, facility inspections and statements provided did not provided evidence to support this allegation.
Administrator qualifications- lack of management oversight over staff at the facility- Administrator has current certification and is present at the facility sufficient time.
Appropriate hands-on training not provided to staff- Records reviewed and statements provided did not provided evidence to support this allegation.
Facility personnel not sufficient in number at all times to meet the needs of residents- Records reviewed, facility inspections and statements provided did not provided evidence to support this allegation.
Call button not working in resident rooms- Records reviewed, facility inspections and statements provided did not provided evidence to support this allegation.
Resident at risk was allowed direct access to personal grooming and hygiene items- Records reviewed, facility inspections and statements provided did not provided evidence to support this allegation.
Locks on resident cabinets are broken- Locks to some cabinets were acknowledged to have not functioned at some time. They did not contain harmful items. The cabinets were replaced timely.
Food is not of the quality or quantity necessary to meet the needs of residents- Records reviewed, facility inspections and statements provided did not provided evidence to support this allegation.

As a result of this investigation, LPA finds allegation to be (US)Unsubstantiated - A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview with administrator.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 8
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
07/25/2022 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 25-AS-20220725140624

FACILITY NAME:AMBER GROVE PLACEFACILITY NUMBER:
045002441
ADMINISTRATOR:CROWLEY, JOHNFACILITY TYPE:
740
ADDRESS:3049 ESPLANADETELEPHONE:
(530) 826-3226
CITY:CHICOSTATE: CAZIP CODE:
95973
CAPACITY:70CENSUS: DATE:
12/15/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:John CrowleyTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Facility did not provide bed rails for resident as needed
Staff do not provide planned activities of residents
Facility did not maintain supplies necessary forpersonal care and maintenace of adequate hygiene practices for residents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 12/15/22 to provide complaint findings. LPA met with staff and explained the purpose of the visit. Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Upon arrival LPA completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA were screened by facility staff upon entering the facility.

LPAs reviewed resident records, facility records and conducted interviews.
The department finds that facility met Tittle 22 requirements.

Facility did not provide bed rails for resident as needed- the resident identified in the complaint did not have an order for bed rails from their physician or from Hospice.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 7 of 8
Control Number 25-AS-20220725140624
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: 12/15/2022
NARRATIVE
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Staff do not provide planned activities of residents- facility has an Activities coordinator and activities calendar as required. Some resident are unable to participate in scheduled activities at times.
Facility did not maintain supplies necessary for personal care and maintenance of adequate hygiene practices for residents- physical inspection and interviews showed required supplies are present and hygiene practices were maintained for the period identified in the complaint.

This agency has investigated the above complaint allegations. We have found that the complaint is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

Exit interview conducted and report provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
LIC9099 (FAS) - (06/04)
Page: 8 of 8