297005250-1-2-2024-59-AS-KHOS-CZ7NW5-20240105094859

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 297005250
Report Date: 01/02/2024
Date Signed: 01/02/2024 02:08:41 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
12/11/2023 and conducted by Evaluator Melissa Parks

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20231211095430

FACILITY NAME:	ATRIA GRASS VALLEY		FACILITY NUMBER:	297005250
ADMINISTRATOR:	NATASHA GEORGES		FACILITY TYPE:	740
ADDRESS:	150 SUTTON WAY		TELEPHONE:	(530) 272-1055
CITY:	GRASS VALLEY	STATE: CA	ZIP CODE:	95945
CAPACITY:	116	CENSUS: 71	DATE:	01/02/2024
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Natasha Georges		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility kitchen is unsanitary

INVESTIGATION FINDINGS:

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LPA Parks arrived on Tuesday January 2, 2024, to conclude a complaint investigation regarding the above allegation.

LPA met with Administrator Natasha and explained the purpose of the visit. Throughout the course of the investigation, LPA interviewed the Administrator, Director of Culinary Services, and various dietary staff. LPA reviewed cleaning schedules. Additionally, LPA reviewed current certification for staff (SERV safe and Food Handlers). The result of the investigation is as follows:

Upon the initial complaint visit, LPA and Administrator toured the dining room and kitchen with the Director of Culinary Services. LPA observed the dining room to be clean and orderly. LPA observed the kitchen to be clean, well-organized, and following current regulations.

Interviews revealed that staff are assigned certain tasks. According to interviews, staff follow this cleaning schedule. No interviews revealed that the facility is kept unsanitary or that cleaning duties are neglected.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa Parks	TELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2024

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 59-AS-20231211095430

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: ATRIA GRASS VALLEY	FACILITY NUMBER: 297005250
	VISIT DATE: 01/02/2024

NARRATIVE

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Staff stated that, at times, they become busy or are behind schedule, but that they work together to accomplish assigned tasks. Additionally, LPA reviewed an internal audit conducted by the facility’s corporate office which shows 100% compliance.

Based on the evidence provided, 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.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa Parks	TELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2024

LIC9099 (FAS) - (06/04)

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