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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 312700033
Report Date: 02/27/2023
Date Signed: 02/27/2023 11:03:50 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 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
09/12/2022 and conducted by Evaluator Melissa Parks
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20220912110444
FACILITY NAME:GRANITE BAY COUNTRYHOUSE LLCFACILITY NUMBER:
312700033
ADMINISTRATOR:JESSICA SANDERSFACILITY TYPE:
740
ADDRESS:8485 BARTON RDTELEPHONE:
(916) 899-6565
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY:49CENSUS: DATE:
02/27/2023
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Jessica SandersTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Resident's dietary needs were not met
Resident's hygiene needs were not met
Staff falsely documented records regarding resident's care
Staff left resident outside unsupervised
Staff did not maintain a comfortable temperature for residents at all times
INVESTIGATION FINDINGS:
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LPA Parks arrived on February 27, 2023 to conclude the investigation regarding the following allegations: resident’s dietary needs were not met, resident's hygiene needs were not met, staff falsely documented records regarding resident's care, staff left resident outside unsupervised, and staff did not always maintain a comfortable temperature for residents. Prior to the visit, 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; LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask.

Throughout the course of the investigation, LPA interviewed staff including Administrator, Wellness Director, Marketing Director, Med Techs, Caregivers, Dietary Supervisor, Cook, and a private caregiver. LPA reviewed Physicians’ Report, care plan, progress notes, and text messages between R1’s POA and the private caregiver. Based on interviews and review of documentation, LPA was able to determine the following:
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2023
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 5
Control Number 25-AS-20220912110444
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: GRANITE BAY COUNTRYHOUSE LLC
FACILITY NUMBER: 312700033
VISIT DATE: 02/27/2023
NARRATIVE
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Allegation: Resident’s dietary needs were not met. R1 was not to eat pork due to religious reasons. Staff interviewed acknowledged that a plate containing pork was served to the resident, but no staff interviewed stated that R1 ate the food. There were text messages between the private caregiver and the POA which stated that the food looked different. The cook and Dietary Supervisor who were interviewed stated that this meat was chicken, not pork. Additionally, the private caregiver acknowledged that R1 did not eat pork while she was with her at the facility.

Allegation: Resident’s hygiene needs were not met. Based on staff interviews, R1 was frequently resistant to care. R1, at times, would become combative with staff. LPA reviewed R1’s progress notes which detail staff attempting multiple times when R1 would refuse personal care or showers. All facility caregivers and med techs interviewed acknowledged that R1 would, at times, resist care, however there were always repeated attempts.

Allegation: staff falsely documented records regarding resident care. LPA reviewed R1's physicians report, care plan, and progress notes. Progress notes which detailed R1's refusal of showers/personal care and behaviors were date stamped and LPA did not observe any late entries. Physicians report and care plan were noted to be current and in compliance.


Allegation: staff left resident outside unsupervised. LPA obtained a picture of a resident appearing to be asleep, outside in the sun. Staff interviewed acknowledged that when the weather is nice, the courtyard doors are open and residents are free to go out to the courtyard. Staff interviewed stated that residents are not outside unsupervised for extended periods of time. While LPA did obtain a picture showing a resident outside, sleeping in direct sunlight, LPA was unable to determine the length of time resident was outside.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 25-AS-20220912110444
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: GRANITE BAY COUNTRYHOUSE LLC
FACILITY NUMBER: 312700033
VISIT DATE: 02/27/2023
NARRATIVE
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Allegation: Staff did not always maintain a comfortable temperature for residents. Staff interviewed stated that each resident room has its own thermostat control. Facility staff and private caregiver interviewed stated that they did not observe R1’s apartment temperature to be uncomfortable for R1.

Based on information obtained during the investigation, LPA finds the allegations to be UNSUBSTANTIATED- a finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred,

Exit interview. Appeal rights were printed and given along with a copy of this report.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 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
09/12/2022 and conducted by Evaluator Melissa Parks
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20220912110444

FACILITY NAME:GRANITE BAY COUNTRYHOUSE LLCFACILITY NUMBER:
312700033
ADMINISTRATOR:JESSICA SANDERSFACILITY TYPE:
740
ADDRESS:8485 BARTON RDTELEPHONE:
(916) 899-6565
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY:49CENSUS: 35DATE:
02/27/2023
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Jessica SandersTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Resident was not refunded for fees after move out
INVESTIGATION FINDINGS:
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LPA Parks arrived on February 27, 2023 to conclude the investigation regarding the following allegation: resident was not refunded for fees after moving out. Prior to the visit, 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; LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask.

Throughout the course of the investigation, LPA interviewed the Administrator and Marketing Director. Additionally, LPA reviewed the signed Admission Agreement for R1 and the account ledger. The Admission Agreement was signed by the POA. Additionally, the section titled ‘Termination of Agreement’ on page 20 of the Admission Agreement was initialed by the POA. The ‘Termination of Agreement’ section detailed the process giving a 30-day notice to vacate. The interview with the Administrator revealed that she discusses each section of the admission agreement with the responsible party at the time of signing. The account ledger shows that R1 currently has a balance for monthly rent ($4,967.04) minus the prorated refund
Unfounded
Estimated Days of Completion: 0
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 25-AS-20220912110444
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: GRANITE BAY COUNTRYHOUSE LLC
FACILITY NUMBER: 312700033
VISIT DATE: 02/27/2023
NARRATIVE
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 for the community fee (60% of the community fee at $1,800) and refunded care fees for 4 days ($157.80). R1 has a total outstanding balance of $3,009.24.

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
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5