045002696-12-14-2021-25-AS-KHOS-C9QS7C-20211215123718

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045002696
Report Date: 12/14/2021
Date Signed: 12/14/2021 11:05:58 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
08/17/2021 and conducted by Evaluator Donna Gurriere

COMPLAINT CONTROL NUMBER: 25-AS-20210817082706

FACILITY NAME:	TOWNSEND HOUSE		FACILITY NUMBER:	045002696
ADMINISTRATOR:	HERTZFELDT, SUSAN		FACILITY TYPE:	740
ADDRESS:	10 ILAHEE LN		TELEPHONE:	(530) 342-4455
CITY:	CHICO	STATE: CA	ZIP CODE:	95973
CAPACITY:	38	CENSUS: 28	DATE:	12/14/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	CHABLIS PASQUALE		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff left resident unattended during toileting.
Staff were not sufficient in numbers to provide services to meet the resident's need for telephone calls.

INVESTIGATION FINDINGS:

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Donna Gurriere, Licensing Program Analyst was in contact and met with Chablis Pasquale, Administrator. It was alleged that Staff left resident unattended during toileting and Staff were not sufficient in numbers to provide services to meet the resident’s need for telephone calls.

LPA Gurriere completed the required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID 19 infection to affirm no COVID-19 related symptoms. The administrator/staff person was contacted to complete a facility risk assessment. LPA Gurriere ensured that hand sanitizer was applied before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask. Additionally, LPA Gurriere was screened by a staff person upon entering the facility.

continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2021

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 25-AS-20210817082706

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: TOWNSEND HOUSE	FACILITY NUMBER: 045002696
	VISIT DATE: 12/14/2021

NARRATIVE

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Staff left resident unattended during toileting.
During the interview process, the administrator and five staff persons were interviewed. In addition, the resident’s Physician Report, medications log, resident’s care plan and staff and resident rosters were reviewed.

It was reported by the administrator and staff that they were not aware that a resident was left unattended during the toileting time. Staff advised that the resident needs standby assistance or that the resident will use the call button to summon staff to assist in toileting. None of the staff were aware that the resident was left unattended. There is not enough evidence to support that the resident was left unattended while toileting. Allegation is Unsubstantiated.

Staff were not sufficient in numbers to provide services to meet the resident’s need for telephone calls.
During the interview process, the administrator and five staff persons were interviewed. In addition, the resident’s Physician Report, medications log, resident’s care plan and staff and resident rosters were reviewed.

During the interview process, the administrator and five staff reported that staff are sufficient in numbers and that they for the most part are available to answer telephone calls. During the work week, there generally is a receptionist available from 8:00 a.m. to 4:30 p.m. It was reported that on a few occasions, a telephone call may have been missed as the staff were providing care to the residents or were assisting the residents to the dining room. It was stated that some residents have their own telephones in their rooms, some of the residents have chosen not to have a phone in their room and are required to rely on staffing. Although there may have been times where a telephone call was missed, overall staff reported that there is sufficient staffing. There is not enough evidence to support that there is insufficient staffing for staff to answer telephone calls. Allegation is Unsubstantiated.

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2021

LIC9099 (FAS) - (06/04)

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