297005250-4-23-2021-25-AS-KHOS-C2QL2Y-20210505082308

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 297005250
Report Date: 04/23/2021
Date Signed: 04/23/2021 02:36:38 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
04/09/2021 and conducted by Evaluator Melissa Lusby

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20210409145404

FACILITY NAME:	ATRIA GRASS VALLEY		FACILITY NUMBER:	297005250
ADMINISTRATOR:	NATASHA A GEORGES		FACILITY TYPE:	740
ADDRESS:	150 SUTTON WAY		TELEPHONE:	(530) 272-1055
CITY:	GRASS VALLEY	STATE: CA	ZIP CODE:	95945
CAPACITY:	116	CENSUS: 88	DATE:	04/23/2021
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Natasha Georges		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility is not refunding community fee per agreement

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Melissa Lusby contacted the facility via telephone to conclude a complaint investigation on 4/23/2021 due to COVID-19 and pre-cautionary measures. LPA identified herself and discussed the purpose of the call and the elements of the allegation with Administrator Natasha Georges.

Based on LPAs interviews and review of documentation, 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. LPA Lusby conducted an exit interview. LPA Lusby emailed Administrator Natasha a copy of the report to review, sign, and send back. A signed copy of this report will be stored in the facility file.

Unfounded

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Melissa Lusby	TELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2021

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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