045002620-7-8-2021-25-AS-LMUZ-C4VPED-20210713111459

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045002620
Report Date: 07/08/2021
Date Signed: 07/08/2021 11:10:57 AM

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
07/07/2021 and conducted by Evaluator Misty Valencia

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20210707161727

FACILITY NAME:	INN AT THE TERRACES, THE		FACILITY NUMBER:	045002620
ADMINISTRATOR:	KEENE, CLIFF		FACILITY TYPE:	740
ADDRESS:	2950 SIERRA SUNRISE TERRACE		TELEPHONE:	(530) 894-5429
CITY:	CHICO	STATE: CA	ZIP CODE:	95928
CAPACITY:	99	CENSUS: 84	DATE:	07/08/2021
		UNANNOUNCED	TIME BEGAN:	09:01 AM
MET WITH:	Wendy Anderson, Resident Services Director		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility is not screening visitors.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Misty Valencia conducted an unannounced complaint investigation visit regarding the above allegation; facility is not screening visitors and met with Wendy Anderson, Resident Services Director (RSD). 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; contacted facility and 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 not screened by front desk clerk.

continued on 9099C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kevin Mknelly	TELEPHONE: (209) -81-1925
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021

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 3

Control Number 25-AS-20210707161727

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: INN AT THE TERRACES, THE	FACILITY NUMBER: 045002620
	VISIT DATE: 07/08/2021

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

During the investigation, it was determined that there was sufficient evidence to substantiate facility did not screen visitors. LPA reviewed sign in/out sheets for July 2, 2021, and July 7, 2021. LPA did not observe Visitor 1 (V1) sign in/out sheet and LPA was not screened on todays date July 08, 2021. On July 8, 2021 RSD failed to protect the personal rights of clients in care to receive safe and healthful accommodations to the health, welfare, and safety of the clients in care. Based on July 8, 2021 facility staff did not ensure visitors entering the facility are adhering to COVID-19 screening protocols according to PIN 21-17 page 3.

Based on the evidence obtained, the preponderance of evidence standard has been met; therefore, the allegation is found to be Substantiated. California Code of Regulations (Title 22) is being cited on the attached LIC 9099D. Appeal rights are provided, and a closure interview was conducted.

SUPERVISOR'S NAME: Kevin Mknelly	TELEPHONE: (209) -81-1925
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 25-AS-20210707161727

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: INN AT THE TERRACES, THE	FACILITY NUMBER: 045002620
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/08/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/09/2021 Section Cited CCR 87468.19(a)(2)	1 2 3 4 5 6 7	Personal Rights of Residents in All care Facilities... To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.	1 2 3 4 5 6 7	Licensee agrees to develop a plan that includes the importance of screening all visitors who enter the facility.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based on LPA's visit and records reviewed front staff did not screen all visitors who entered the facility. This posed an immediate risk to the residents in care.	8 9 10 11 12 13 14	Licensee will submit their plan for developing/training of such standards and include that training will be completed and proof submitted by 07/13/2021.
	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: Kevin Mknelly	TELEPHONE: (209) -81-1925
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3