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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045002696
Report Date: 01/31/2022
Date Signed: 01/31/2022 10:45:11 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
08/25/2021 and conducted by Evaluator Donna Gurriere
COMPLAINT CONTROL NUMBER: 25-AS-20210825134854
FACILITY NAME:TOWNSEND HOUSEFACILITY NUMBER:
045002696
ADMINISTRATOR:HERTZFELDT, SUSANFACILITY TYPE:
740
ADDRESS:10 ILAHEE LNTELEPHONE:
(530) 342-4455
CITY:CHICOSTATE: CAZIP CODE:
95973
CAPACITY:38CENSUS: 28DATE:
01/31/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:CHABLIS PASQUALETIME COMPLETED:
10:20 AM
ALLEGATION(S):
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Staff did not ensure that a visitor followed the Covid 19 mask guidance.
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 did not ensure that a visitor followed the Covid 19 mask guidance.

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 BrysonTELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2022
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 2
Control Number 25-AS-20210825134854
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: 01/31/2022
NARRATIVE
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**continued**


Staff did not ensure that a visitor followed the Covid 19 mask guidance.
During the interview process, the administrator, five staff persons and three residents were interviewed. None of the staff persons or residents indicated that there was a visitor that did not follow the Covid 19 mask guidance. In addition, all staff persons stated that they are prepared to speak out and ensure that all visitors follow the Covid 19 mask guidance when at the facility.

Overall, it could not be proven that a visitor did not follow the Covid 19 mask guidance. Although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are Unsubstantiated. No deficiencies cited.
SUPERVISOR'S NAME: Rayna L BrysonTELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2