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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 292700563
Report Date: 11/29/2022
Date Signed: 11/29/2022 12:59:13 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 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
10/31/2022 and conducted by Evaluator Melissa Parks
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20221031085945
FACILITY NAME:CASCADES OF GRASS VALLEYFACILITY NUMBER:
292700563
ADMINISTRATOR:ROBERT GODFREYFACILITY TYPE:
740
ADDRESS:415 SIERRA COLLEGE DRIVETELEPHONE:
(530) 272-8002
CITY:GRASS VALLEYSTATE: CAZIP CODE:
95945
CAPACITY:65CENSUS: 48DATE:
11/29/2022
UNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Robert GodfreyTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Staff do not provide activities for residents in care
INVESTIGATION FINDINGS:
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LPA Parks arrived on Tuesday November 29, 2022 to conduct a complaint investigation regarding the allegation that facility is not providing activies for residents. Prior to the visit, LPA completed the required COVID-19 testing protocols and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask.

LPA Parks learned that S1 voluntarily quit as Activity Director on October 28, 2022. The facility has a part time activities assistant who conducts activities on Sundays and Mondays. Additionally, care staff conducted activities for residents. On November 15, 2022, S2 (who previously worked on-call in the activities department) returned from travel and began fulfulling the Activities Director duties. Activities include: daily exercise, armchair travel, arts and crafts, bingo, tai chi, and wine and cheese. Staff interviewed stated that if an activities employee was not present, care staff or management would assist with activities. Additionally, S3 (who has been on leave) is returning as a full time activities assistant on December 5th. LPA obtained calendars which show daily activities and any holiday events.
Unfounded
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 25-AS-20221031085945
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: CASCADES OF GRASS VALLEY
FACILITY NUMBER: 292700563
VISIT DATE: 11/29/2022
NARRATIVE
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While there was a gap in having a full time Activity Director, there was no evidence that activities were not being conducted. The facility immediately began to problem solve until a full time activities person was established (approximately two weeks).

Based on the evidence provided, the preponderance of evidence standards was not met, therefore, the above allegation is found to be UNFOUNDED. An unfounded allegation means that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview conducted. A copy of this report was left at the facility

SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2