097004177-5-21-2021-25-AS-MSEY-C3BNLM-20210524103347

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 097004177
Report Date: 05/21/2021
Date Signed: 05/21/2021 12:58:30 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
04/22/2021 and conducted by Evaluator Michael Smith

COMPLAINT CONTROL NUMBER: 25-AS-20210422143957

FACILITY NAME:	PONTE PALMERO		FACILITY NUMBER:	097004177
ADMINISTRATOR:	KASNER, GREGORY		FACILITY TYPE:	740
ADDRESS:	3083 PONTE MORINO DRIVE		TELEPHONE:	(530) 677-9100
CITY:	CAMERON PARK	STATE: CA	ZIP CODE:	95682
CAPACITY:	250	CENSUS: 168	DATE:	05/21/2021
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Greg Kasner		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Resident is restricted from dining privileges.

Resident is restricted from Activities.

Resident is restricted from transportation services.

INVESTIGATION FINDINGS:

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LPA Smith conducted an unannounced complaint visit and met with Gregory Kasner.

R1 was restricted from the dining room, activities and transportation for continued disruptive behaviors, yelling, shouting, unwelcome interactions with staff and other residents, verbal aggression, erratic behavior and inappropriate / unwelcomed touching of staff and residents. Eight witness statements documented the above referenced behaviors. Based on safety of other residents and staff, R1 was limited to certain interactions. Facility offered alternatives for R1, such as food delivery, solo transportation to / from medical and dental appointments.

As a result of this investigation, LPA finds the allegation that resident is restricted from dining privileges, resident is restricted from activities and resident is restricted from transportation services to be UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Michael Smith	TELEPHONE: (916) 208-7807
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2021

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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