292700563-9-26-2023-59-AS-MSEY-CW3T5D-20230927142523

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 292700563
Report Date: 09/26/2023
Date Signed: 09/26/2023 02:33:39 PM

Unfounded

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
09/08/2023 and conducted by Evaluator Melissa Parks

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20230908081246

FACILITY NAME:	CASCADES OF GRASS VALLEY		FACILITY NUMBER:	292700563
ADMINISTRATOR:	HALEY PARKER		FACILITY TYPE:	740
ADDRESS:	415 SIERRA COLLEGE DRIVE		TELEPHONE:	(530) 272-8002
CITY:	GRASS VALLEY	STATE: CA	ZIP CODE:	95945
CAPACITY:	65	CENSUS: 55	DATE:	09/26/2023
		UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Haley Parker		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Residents are not being showered timely
Residents are left in soiled diapers/clothing
Resident hygiene needs are not being met
Resident rooms are not cleaned timely
Staff do not re-order diapers and wipes timely for residents

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

LPA Parks arrived on Tuesday September 26, 2023, to conclude a complaint investigation regarding the above allegations.

LPA met with Administrator Haley and explained the purpose of the visit. Throughout the course of the investigation, LPA interviewed the Administrator, Wellness Director, Med techs, and caregivers. LPA reviewed staffing schedules for memory care and assisted living. Additionally, LPA reviewed LIC602s and care plans for R1, R2, and R3. The result of the investigation is as follows:

Upon the initial complaint visit, LPA and Administrator toured the facility and visited all apartments which have residents who are provided incontinence care. This included 10 apartments on the assisted living side and 13 apartments in memory care. LPA noted that all apartments and bathrooms were clean and organized. Additionally, LPA observed residents to be clean, groomed, odor free.

Unfounded

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa Parks	TELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

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 59-AS-20230908081246

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: CASCADES OF GRASS VALLEY	FACILITY NUMBER: 292700563
	VISIT DATE: 09/26/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA noted a slight odor in apartment which housed R1 and R2. While discussing this with the Administrator, LPA learned that a care conference was already scheduled to discuss increasing the care for R2. Staff interviews noted that R2 was resistant at times to care. LPA interviewed staff regarding the allegations of rooms not being cleaned timely. All interviews indicated that rooms were cleaned timely. All rooms were deep cleaned weekly and cleaned as needed by care staff.

Interviews revealed that residents are showered according to their care plan. Staff stated that if residents refuse showers, they are asked again, or ask the following shift to attempt. Interviews stated that residents are toileted according to their care plan. Additionally, staff stated that resident are routinely toileted when incontinence care is provided. No staff interviews acknowledged that residents’ incontinence needs are not being met. Additionally, staff stated that resident’s hygiene needs are being met.

LPA observed the facility’s supply closet which contains additional incontinence supplies should residents need any. Interviews acknowledged that staff could use the supply closet if the resident’s personal supply is out. Additionally, all interviews stated that at no time has the facility been without gloves for the staff.

Based on the evidence provided, the preponderance of evidence standards was not met, therefore, the above allegations are 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 Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa Parks	TELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2