295001463-6-14-2021-25-AS-MSEY-C43LZQ-20210617091220

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 295001463
Report Date: 06/14/2021
Date Signed: 06/14/2021 02:30:49 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/07/2021 and conducted by Evaluator Bethany Huusfeldt

COMPLAINT CONTROL NUMBER: 25-AS-20210607101305

FACILITY NAME:	SIERRA VIEW MANOR		FACILITY NUMBER:	295001463
ADMINISTRATOR:	MORGAN WHINERY		FACILITY TYPE:	740
ADDRESS:	120 DORSEY DRIVE		TELEPHONE:	(530) 273-4849
CITY:	GRASS VALLEY	STATE: CA	ZIP CODE:	95945
CAPACITY:	58	CENSUS: 29	DATE:	06/14/2021
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Morgan Whinery, Administrator		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Facility do not maintain a comfortable temperature for resident(s).

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bethany Huusfeldt Mirlohi arrived unannounced to open allegations listed above. LPA met with administrator Morgan Whinery during today's inspection. LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted licensee and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Masks.
During today's inspection LPA reviewed records, toured the facility, and interviewed residents. LPA investigated allegation, "Facility do not maintain a comfortable temperature for residents". LPA toured the facility and observed the facility at a comfortable temperature of 74.
Continuation on 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Huusfeldt	TELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2021

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 4

Control Number 25-AS-20210607101305

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: SIERRA VIEW MANOR	FACILITY NUMBER: 295001463
	VISIT DATE: 06/14/2021

NARRATIVE

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LPA interviewed administrator concerning air conditioning issues. Administrator stated on May 14th the air conditioning froze over. A repair company came on May 14th and fixed the issue. The repair company came again on May 16th to check on the air conditioning system. Again on June 6th the air conditioning froze over and the repair company came on June 6th to fix the issue. Administrator then contacted a bigger air conditioning company to look at the system on June 8th, and the company fixed several leaks that were found. Administrator stated their were concerns with one residents room getting too hot, and they bought a window air conditioning for resident's room. LPA observed that resident now has an individual air conditioning unit for both windows in their room. Interviews with residents report facility is a comfortable temperature and issue has been resolved.
Due to the information gathered, LPA finds that although the facility did have an issue with the air conditioning, the facility took the proper steps to resolve the issue in a timely manner. Allegation is unsubstantiated.

Exit interview conducted. No deficiencies cited.

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Huusfeldt	TELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/07/2021 and conducted by Evaluator Bethany Huusfeldt

COMPLAINT CONTROL NUMBER: 25-AS-20210607101305

FACILITY NAME:	SIERRA VIEW MANOR		FACILITY NUMBER:	295001463
ADMINISTRATOR:	MORGAN WHINERY		FACILITY TYPE:	740
ADDRESS:	120 DORSEY DRIVE		TELEPHONE:	(530) 273-4849
CITY:	GRASS VALLEY	STATE: CA	ZIP CODE:	95945
CAPACITY:	58	CENSUS: 29	DATE:	06/14/2021
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Morgan Whinery, Administrator		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Inadequate food service is being provided to resident(s).

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bethany Huusfeldt Mirlohi arrived unannounced to open allegations listed above. LPA met with administrator Morgan Whinery during today's inspection. LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted licensee and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Masks.
During today's inspection LPA reviewed records, toured the facility, and interviewed residents. LPA investigated allegation, "Inadequate food service is being provided to resident(s)". LPA toured the facility and the kitchen area. LPA found 2-day perishable and 7-day non-perishable amount of food at the facility.
Continuation on 9099-C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Huusfeldt	TELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 25-AS-20210607101305

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: SIERRA VIEW MANOR	FACILITY NUMBER: 295001463
	VISIT DATE: 06/14/2021

NARRATIVE

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LPA observed fresh fruits and vegetables, yogurts and other dairy items, meats, and pantry items such as pastas, rices, and snack items. LPA reviewed resident menus and found facility had a variety of food options each day including snacks. LPA interviewed 5 residents in care. 3 of the 5 residents were satisfied with the food and stated that the food is improving. 2 of 5 residents had concerns with the quality and variety of foods, and found some meals were not appropriate for the population residing at the facility. 5 of 5 residents stated they are served fruits and vegetables daily with their meals and are provided snacks if requested. Due to the information gathered, LPA finds allegation to be unfounded.

Exit interview conducted. No deficiencies cited.

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Huusfeldt	TELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 4