292700174-4-25-2024-59-AS-TORZ-D5GPEV-20240521111547

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 292700174
Report Date: 04/25/2024
Date Signed: 04/25/2024 02:40:03 PM

Unsubstantiated

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
02/05/2024 and conducted by Evaluator Kerry Hiratsuka

COMPLAINT CONTROL NUMBER: 59-AS-20240205165106

FACILITY NAME:	BRUNSWICK VILLAGE		FACILITY NUMBER:	292700174
ADMINISTRATOR:	LAINE, KRISTIE		FACILITY TYPE:	740
ADDRESS:	316 OLYMPIA PARK CIRCLE		TELEPHONE:	(530) 274-1992
CITY:	GRASS VALLEY	STATE: CA	ZIP CODE:	95945
CAPACITY:	100	CENSUS: 56	DATE:	04/25/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Kristie Laine		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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1. Staff do not provide adequate food service to resident.
2. Staff do not treat resident with dignity.
3. Staff do not ensure a comfortable living environment for resident.

INVESTIGATION FINDINGS:

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LPA Hiratsuka conducted the investigation into the allegations above.

LPA Hiratsuka conducted interviews, reviewed files, and walked around.

1. One resident stated the food served is spoiled and not cooked and served properly. The one resident showed LPA pictures of grapes and to LPA the grapes appeared to have a blemish, not spoiled. LPA could not determine the condition of the fruit because it was a picture. Nine other residents interviewed have no issues with the food and stated the food is really good and no issues with the way it is served. The cooks have all the required qualifications per Title 22 regulations. LPA observed the food supply and did not observe any spoiled food. LPA is unable to prove or disprove the allegation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Kerry Hiratsuka	TELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

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-20240205165106

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: BRUNSWICK VILLAGE	FACILITY NUMBER: 292700174
	VISIT DATE: 04/25/2024

NARRATIVE

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2. One resident stated the staff are very rude to them. Staff interviewed stated there is one resident who cannot be pleased no matter what they do. Nine residents interviewed stated the staff are very good to them. LPA observed interactions between residents and staff during visits dated 04/10/2024, and today and did not observe any negative interactions. LPA cannot prove or disprove the allegation.

3. One resident stated there is an issue with the kitchen and it causes the apartment to vibrate and have loud noises. The one resident was offered to move to another apartment and the one resident refused. Executive Director Kristie Laine had the walk-in refrigerator and walk-in freezer inspected and the company that did the inspection did not find anything wrong with the units. LPA interviewed the residents in the apartments on both sides of the one resident with the issues and those residents do not have any issues. LPA interviewed seven other residents and they also stated there were no issues. LPA cannot prove or disprove the allegation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are UNSUBSTANTIATED.

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Kerry Hiratsuka	TELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

LIC9099 (FAS) - (06/04)

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