045002620-11-9-2021-25-AS-RLBN-C8STMU-20211115135141

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045002620
Report Date: 11/09/2021
Date Signed: 11/09/2021 01:14:18 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
08/11/2021 and conducted by Evaluator Misty Valencia

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20210811142633

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: 86	DATE:	11/09/2021
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Cliff Keene, Administrator		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Unlawful eviction

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Misty Valencia and Dawn Keane conducted an unannounced complaint investigation visit to deliver findings for the above allegation. LPA met with Cliff Keene, Administrator. Prior to initiating the complaint visit, LPA completed the required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID related symptoms. LPA contacted Administrator 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: N95 mask. Additionally, LPA was assessed at the front desk.

continued on 9099C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021

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-20210811142633

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: 11/09/2021

NARRATIVE

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Unlawful eviction

LPA interviewed Admin, RSD, residents, and reviewed records. During the investigation, it was determined that there was sufficient evidence to substantiate Resident was given an unlawful eviction. During the investigation, the Admin admitted this is true, but the notice is being rescinded and the facility did not follow through with the eviction.

Based on the findings of this investigation LPA finds allegations to be SUBSTANTIATED - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. LPA will not be citing for this substituted allegation due to the facility not following through with the eviction. Facility understands that this is a citable allegation and may be cited in the future for any unlawful evictions.

No deficiencies are cited during today's visit.

An exit interview was conducted with Administrator and copy of report was provided.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 4

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
08/11/2021 and conducted by Evaluator Misty Valencia

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20210811142633

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: 86	DATE:	11/09/2021
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Cliff Keene, Administrator		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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9

facility did not provide resident with activities that met residents needs
facility is not meeting the resident's needs as identified in the pre-admission appraisal

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 to deliver findings for the above allegations. LPA met with Cliff Keene, Administrator. Prior to initiating the complaint visit, LPA completed the required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID related symptoms. LPA contacted RSD and complete a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 mask. Additionally, LPA was assessed at the front desk.

continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 25-AS-20210811142633

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: 11/09/2021

NARRATIVE

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Facility did not provide resident with activities that met residents needs

Facility is not meeting the resident's needs as identified in the pre-admission appraisal

During interviews with Administrators, staff, residents and records reviewed, it was determined that Facility did not provide resident with activities that met residents needs and facility is not meeting the resident's needs as identified in the pre-admission appraisal to be unsubstantiated. LPA interviewed Admin, RSD, residents, and reviewed records. During the investigation, it was determined through interviews with Admin, RSD, and six of six 6/6 residents, who all agreed that their needs are being met and they have no complaints. The preponderance of evidence standard has not been met. The allegations are unsubstantiated.

This agency has investigated the above listed allegations. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred therefore, we have found the allegations to be UNSUBSTANTIATED.

No deficiencies are cited during today's visit.

An exit interview was conducted with Administrator and copy of report was provided.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 4