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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045002696
Report Date: 09/18/2023
Date Signed: 09/18/2023 09:36:47 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/16/2023 and conducted by Evaluator Jaynae Boyles
COMPLAINT CONTROL NUMBER: 59-AS-20230816163819
FACILITY NAME:TOWNSEND HOUSEFACILITY NUMBER:
045002696
ADMINISTRATOR:PASQUALE, CHABLISFACILITY TYPE:
740
ADDRESS:10 ILAHEE LNTELEPHONE:
(530) 342-4455
CITY:CHICOSTATE: CAZIP CODE:
95973
CAPACITY:38CENSUS: 31DATE:
09/18/2023
UNANNOUNCEDTIME BEGAN:
08:56 AM
MET WITH:Administrator -Chablis PasqualeTIME COMPLETED:
09:45 AM
ALLEGATION(S):
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Staff did not supervise resident while outside in extreme temperatures
INVESTIGATION FINDINGS:
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On September 18, 2023, LPA's Boyles and Avila arrived to the facility unannouced for a complaint investigation visit.
On August 15, 2023, R1 was found unresponsive outside on the patio by another resident family member at approximately 4:11 PM. Per interviews with staff, R1 was taken outside after lunch by the receptionist who did not tell relay this information to other facility staff. R1 had been sitting outside for approximately 2 hours and 45 minutes, or longer when temperatures were increasing and reached 108 degrees (F) by 2:00 p.m. The temperatures were verified by a local city weather graph (timeanddate.com). When R1 arrived at the hospital their body temperature was 106.1 degrees (F).

Based on LPAs interviews which were conducted and record reviews, the preponderance of
evidence standard has been met; therefore, the above allegation are found to be SUBSTANTIATED. California Code of Regulations Title 22 and or the California Health and Safety Code are being cited on the attached LIC 9099D. Appeal rights left with Adminstrator.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Jaynae BoylesTELEPHONE: (916) 917-3040
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
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 59-AS-20230816163819
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: TOWNSEND HOUSE
FACILITY NUMBER: 045002696
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/18/2023
Section Cited
CCR
87411(a)
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87411(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs or the physical arrangements of the facility require such additional staff for the provision of adequate services. The requirement is not met as evidence by:
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Staff are checking for all clients within the wing assigned. Training for heat stroke/illness was adminstered for all staff. Staff are setting timers for residents when outside, and bringing the resident back inside.
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Based on observation, interviews and record review, the licensee did not provide adequate care and supervision by leaving a dementia resident unsupervised outside for an extended period of time in extreme heat, which poses an immediate Health, Safety, Personal Rights risk to persons in care.
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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: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Jaynae BoylesTELEPHONE: (916) 917-3040
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
LIC9099 (FAS) - (06/04)
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