275202689-2-10-2023-24-AS-BCHN-CNX3RV-20230210172923

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 275202689
Report Date: 01/31/2023
Date Signed: 02/10/2023 09:22:27 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/15/2022 and conducted by Evaluator Sarah Hurt

COMPLAINT CONTROL NUMBER: 24-AS-20221115092842

FACILITY NAME:	SONGBIRD IN THE COUNTRY		FACILITY NUMBER:	275202689
ADMINISTRATOR:	MAZIREK, BETH		FACILITY TYPE:	740
ADDRESS:	15961 TORO HILLS AVENUE		TELEPHONE:	(831) 998-8708
CITY:	SALINAS	STATE: CA	ZIP CODE:	93908
CAPACITY:	12	CENSUS: 10	DATE:	01/31/2023
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Licensee, Mathew Mazirek		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff yells at residents in care.
Staff handles residents in a rough manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to conduct a complaint investigation. LPA Hurt met with Licensee Mathew Mazirek and explained the purpose of today's visit.

Regarding the allegations Staff yells at residents in care. Based on LPA observation, records reviewed, and interviews the staff does not yell at residents in care. LPA Hurt interviewed 2 facility staff during this investigation, 1 staff stated they have witnessed Staff 1 yelling at Resident 1 on several occasions, and reporting party stated they also heard facility staff yelling at a resident who wasn’t eating their food. LPA Hurt observed during visits to the facility on 11/16/2022, and 01/19/2023 facility staff, and Resident 1’s responsible party attempting to communicate with them by speaking very loudly (yelling) and close to their face. Resident 1’s Physician Report documents them having Auditory Impairment. Resident 1's Needs and Services Plan documents them as being extremely hard of hearing/def and does not use hearing aids. The facility has a total of 4 residents that are considered extremely hard of hearing.
Continued on 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

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 24-AS-20221115092842

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: SONGBIRD IN THE COUNTRY	FACILITY NUMBER: 275202689
	VISIT DATE: 01/31/2023

NARRATIVE

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...Continued from 9099

LPA Hurt interviewed Resident 1’s Responsible party who stated Resident 1 is extremely hard of hearing and it is very difficult to communicate with them without getting very close to them and talking really loud directly into their ear. Therefore, this allegation is UNSUBSTANTIATED. A finding that an allegation is unsubstantiated means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

Regarding the allegations Staff handles residents in a rough manner. Based on interviews, records reviewed, and observation the staff is not handling residents in a rough manner. Reporting party stated they witnessed facility staff handling Resident 2 and Resident 3 in a rough manner. LPA Hurt observed facility resident 2, and Resident 3 neither had any marks that could be considered concerning bruising or marks on their bodies. LPA Hurt interviewed 3 facility staff, and 2 hospice staff. Hospice staff interviewed stated they have not seen any concerning bruising on Resident 2 who she provided care for on 01/19/2023. LPA Hurt reviewed Physician Reports and Needs and Services Plans for Resident 2, and Resident 3 both document resident's have diagnosed dementia and are unable to be interviewed. Therefore, this allegation is UNSUBSTANTIATED. A finding that an allegation is unsubstantiated means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

No Deficiencies Cited Per Title 22 Regulations. Exit interview conducted with Licensee Mathew Mazirek, and a copy of this report left at the facility.

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

LIC9099 (FAS) - (06/04)

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