297005250-7-10-2020-27-AS-LMUZ-BRGRCN-20200713125438

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 297005250
Report Date: 07/10/2020
Date Signed: 07/10/2020 02:56:50 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/25/2020 and conducted by Evaluator Bethany Huusfeldt

COMPLAINT CONTROL NUMBER: 27-AS-20200225150712

FACILITY NAME:	ATRIA GRASS VALLEY		FACILITY NUMBER:	297005250
ADMINISTRATOR:	RIST, ALICIA		FACILITY TYPE:	740
ADDRESS:	150 SUTTON WAY		TELEPHONE:	(530) 272-1055
CITY:	GRASS VALLEY	STATE: CA	ZIP CODE:	95945
CAPACITY:	116	CENSUS: 87	DATE:	07/10/2020
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Alicia Rist, Administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Residents are not being provided a safe/sanitary environment
Facility staff are not properly storing/labeling food items
Facility staff are not properly trained
Facility has scabies outbreak

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bethany Huusfeldt spoke with administrator Alicia Rist on 7/10/20 to deliver complaint findings. Due to COVID-19 restrictions LPA spoke to licensee over the phone.
LPA investigated the allegation of “Facility staff are not properly storing/labeling food items”. CCL toured the kitchen on 03/03/20 and on 7/10/20 and found appropriate foods were labeled. LPA reviewed facility policy on when food must be covered, labeled, and dated. LPA interviewed 7 staff members in which all indicated they were aware of the policy and continuously practice the proper way to store and label food. Administrator stated internal audits occur twice yearly to check on this issue. Due to the information gathered LPA found allegation to be unfounded.
LPA investigated the allegation of “Facility are not properly trained”. LPA reviewed kitchen staff training and interviewed 7 staff members.
Continuation 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: 07/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2020

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 27-AS-20200225150712

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: ATRIA GRASS VALLEY	FACILITY NUMBER: 297005250
	VISIT DATE: 07/10/2020

NARRATIVE

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LPA observed staff current food handler’s certificates, in-service training's throughout 2018, 2019, 2020, and initial training that is required of kitchen staff. LPA found requirements for kitchen staff have been obtained. LPA finds allegation to be unfounded.

LPA investigated the allegation of “Residents are not being provided a safe/sanitary environment”. LPA interviewed staff and residents. Additionally, CCL toured the kitchen and dining room area on 3/03/20 and 7/10/20. LPA’s found kitchen and dining area to be clean and in sanitary condition. LPA interviewed 3 current resident’s in care. Residents interviewed indicated dining room has always been clean and sanitary. Residents stated they have not observed the dining room to be unsanitary. Resident’s indicated staff clean the tables after each resident use. Staff interviews indicated they have a cleaning schedule. Staff clean the kitchen frequently throughout the day, and then thoroughly after each meal. Due to the information gathered LPA finds allegation to be unfounded.

LPA investigated the allegation of “facility has scabies outbreak”. LPA interviewed staff concerning outbreak. LPA interviewed care director in which they stated there has not been a scabies outbreak within the facility in 2020 or since she had worked at the facility. LPA interviewed the administrator in which she stated there has never been an outbreak at the facility. Due to the information gathered, allegation is found to be UNFOUNDED.

A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Exit Interview conducted.

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Huusfeldt	TELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2020

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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/25/2020 and conducted by Evaluator Bethany Huusfeldt

COMPLAINT CONTROL NUMBER: 27-AS-20200225150712

FACILITY NAME:	ATRIA GRASS VALLEY		FACILITY NUMBER:	297005250
ADMINISTRATOR:	RIST, ALICIA		FACILITY TYPE:	740
ADDRESS:	150 SUTTON WAY		TELEPHONE:	(530) 272-1055
CITY:	GRASS VALLEY	STATE: CA	ZIP CODE:	95945
CAPACITY:	116	CENSUS: 87	DATE:	07/10/2020
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Alicia Rist, Administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility staff are not following proper food service practices which protect food from contamination.
Residents are not being provided adequate food service.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bethany Huusfeldt spoke with administrator Alicia Rist on 7/10/20 to deliver complaint findings. Due to COVID-19 restrictions LPA spoke to licensee over the phone.
LPA investigated the allegation of “Facility staff are not following proper food service practices which protect food from contamination.” LPA reviewed staff training, toured the kitchen, interviewed staff and interviewed residents. Training indicates kitchen staff have up to date food handler certificates. Tour of the kitchen area was conducted on 3/03/20 and 7/10/20. Kitchen and dining room area was observed to be clean and sanitary. Staff interviews indicate there is sufficient and quality food available. Resident interviews indicate food is available for all 3 meals and snacks, and they are satisfied with quality of food. Residents have not experienced any issues with the food service. LPA was unable to get further information from relevant party. Due to the information gathered LPA finds allegation to be UNSUBSTANTIATED.
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: 07/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2020

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 27-AS-20200225150712

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: ATRIA GRASS VALLEY	FACILITY NUMBER: 297005250
	VISIT DATE: 07/10/2020

NARRATIVE

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LPA investigated the allegation of “Residents are not being provided adequate food service”. LPA reviewed staff training, toured the kitchen, interviewed staff and interviewed residents. Interviews with staff indicate there is a diet board inside the kitchen which has resident picture and dietary restrictions. Interviews with staff indicate that they are all aware of this board in the kitchen. Interviews with residents indicate there dietary needs are being satisfied. 1 resident stated they were gluten free, and there are options for them. LPA was unable to get further information from relevant party. Due to the information gathered LPA finds allegation to be UNSUBSTANTIATED.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview and report provided.

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany Huusfeldt	TELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2020

LIC9099 (FAS) - (06/04)

Page: 4 of 4