295002836-9-8-2022-25-AS-APEZ-CJFP3Y-20220920105815

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 295002836
Report Date: 09/08/2022
Date Signed: 09/08/2022 11:37:21 AM

Unsubstantiated

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
07/13/2022 and conducted by Evaluator Jacob Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20220713152751

FACILITY NAME:	SIERRA VIEW SENIOR LIVING		FACILITY NUMBER:	295002836
ADMINISTRATOR:	WINGET, LISA VIXIE		FACILITY TYPE:	740
ADDRESS:	120 DORSEY DRIVE		TELEPHONE:	(530) 273-4849
CITY:	GRASS VALLEY	STATE: CA	ZIP CODE:	95945
CAPACITY:	49	CENSUS: 33	DATE:	09/08/2022
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Lisa Vixie Winget, Executive Director		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility not providing adequate staffing.
Staff speak inappropriately to residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jacob Williams arrived at the facility unannounced on 09/08/2022 to deliver complaint findings for a complaint Community Care Licensing (CCL) received on 07/13/2022. LPA met with Lisa Vixie Winget, Executive Director, and explained the purpose of the visit. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA was screened by facility staff upon entering the facility.

Throughout the course of the complaint investigation, the Department conducted interviews with staff and residents, and obtained pertinent documents such as staffing schedule and program design.

Continued on page LIC-9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Jacob Williams	TELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

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 25-AS-20220713152751

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 SENIOR LIVING	FACILITY NUMBER: 295002836
	VISIT DATE: 09/08/2022

NARRATIVE

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Allegation: Facility not providing adequate staffing.

While the facility has experienced staffing issues, the facility has proven that they have worked to improve the situation. Facility has used outside staffing agency as well as worked with a consultant to improve in-house issues amongst staff. Of the four residents interviewed, zero residents had any issues with the care being provided.

Allegation: Staff speak inappropriately to residents.

According to complainant, one staff person speaks badly to residents, and that person talks like that on a daily basis. Of the four residents interviewed, none said they have ever been spoken to rudely nor have they witnessed any staff speaking rudely to any other residents. Of the four staff interviewed, zero said they have witnessed any other staff speaking rudely to residents.

Due to the information above, LPA finds the allegations to be UNSUBSTANTIATED meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview conducted with Executive Director, copy of report was provided via email.

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Jacob Williams	TELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

LIC9099 (FAS) - (06/04)

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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
07/13/2022 and conducted by Evaluator Jacob Williams

COMPLAINT CONTROL NUMBER: 25-AS-20220713152751

FACILITY NAME:	SIERRA VIEW SENIOR LIVING		FACILITY NUMBER:	295002836
ADMINISTRATOR:	WINGET, LISA VIXIE		FACILITY TYPE:	740
ADDRESS:	120 DORSEY DRIVE		TELEPHONE:	(530) 273-4849
CITY:	GRASS VALLEY	STATE: CA	ZIP CODE:	95945
CAPACITY:	49	CENSUS: 33	DATE:	09/08/2022
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Lisa Vixie Winget, Executive Director		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff residing at facility.

INVESTIGATION FINDINGS:

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LPA Williams arrived at the facility unannounced on Thursday 09/08/2022 to conclude a complaint investigation regarding the above allegation ‘staff residing at facility’. 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, applied hand sanitizer before entering the facility and wore a surgical mask.

Throughout the course of the investigation, LPA interviewed staff, residents and reviewed documents. Although staff is confirmed to be living in the facilty, there is no Title 22 regulation being violated. Facility is using staff to assure appropriate coverage during the night shift.

Based on LPAs interviews and review of documentation, 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.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Jacob Williams	TELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

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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