185002415-6-7-2020-25-AS-RLBN-BQCV4M-20200607160633

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 185002415
Report Date: 06/04/2020
Date Signed: 06/07/2020 08:19:31 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 COHASETT RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/02/2020 and conducted by Evaluator Misty Valencia

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20200602113534

FACILITY NAME:	EAGLE LAKE VILLAGE		FACILITY NUMBER:	185002415
ADMINISTRATOR:	DRUMMOND, LYNN		FACILITY TYPE:	740
ADDRESS:	2001 PAUL BUNYAN RD		TELEPHONE:	(530) 257-6673
CITY:	SUSANVILLE	STATE: CA	ZIP CODE:	96130
CAPACITY:	76	CENSUS: 36	DATE:	06/04/2020
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Lynn Drummond, Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Medication error-Medication Overdose

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Misty Valencia conducted an unannounced complaint phone call regarding the allegation above and spoke with Lynn Drummond, Administrator.
On 06/02/2020, LPA received a complaint regarding a medication error/medication overdose. Banner Hospital provided documentation that the results came back and it was a false positive test, in which an overdose did not occur. The department has investigated this allegation and found this allegation to be unfounded. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.
There were no citations issued during today's visit, copy of report was given. An exit interview was conducted with Lynn Drummond, via telephone and a copy of this report, dated June 4, 2020 was provided to via email and an electronic email read receipt confirms receiving this document.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2020

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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