312700033-4-8-2022-25-AS-TORZ-CE2P42-20220502105827

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 312700033
Report Date: 04/08/2022
Date Signed: 04/08/2022 04:19:57 PM

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
01/10/2022 and conducted by Evaluator Mai Thao

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20220110105455

FACILITY NAME:	GRANITE BAY COUNTRYHOUSE LLC		FACILITY NUMBER:	312700033
ADMINISTRATOR:	JANELLE LOPEZ		FACILITY TYPE:	740
ADDRESS:	8485 BARTON RD		TELEPHONE:	(916) 899-6565
CITY:	GRANITE BAY	STATE: CA	ZIP CODE:	95746
CAPACITY:	49	CENSUS: 19	DATE:	04/08/2022
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Jessica Sanders, Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff not providing assistance to residents in a timely manner.
Residents left in soiled clothing for extended period of time.

INVESTIGATION FINDINGS:

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On 4/8/2022, Licensing Program Analysts (LPAs) Mai Thao and Lavinia Muscan arrived at the facility unannounced to conduct a Complaint Investigation Visit with the above allegations and met with Jessica Sanders, Administrator. Prior to visit, LPAs 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 they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 Mask and surgical mask.

During today’s visit, LPAs conducted interviews and delivered findings.

(Continue 9099-C…)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Mai Thao	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2022

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-20220110105455

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: GRANITE BAY COUNTRYHOUSE LLC	FACILITY NUMBER: 312700033
	VISIT DATE: 04/08/2022

NARRATIVE

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Staff not providing assistance to residents in a timely manner
Majority of the residents who were interviewed were not able to communicate with LPAs due to diagnosis of Dementia and/or refused. Resident 1 (R1) stated that staff are good. R1 also stated that if R1 needs help staff is always available to help R1. Staff stated in interviews that staffing can be challenging, but staff are still able to meet the needs of all residents in care. Staff also stated in interviews that if a care staff calls in, then a staff from management will fill in. Administrator stated that the facility utilizes an outside staffing agency and also have staff working overtime to cover shifts. 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

Residents left in soiled clothing for extended period of time.
Majority of the residents who were interviewed were not able to communicate with LPAs due to diagnosis of Dementia and/or refused. Some residents states that they do not need assistance with dressing. Staff 1 (S1) stated that sometimes residents refused, but there are multiple attempts to assist residents through distractions, and/or call for additional assistance from another staff. Staff stated in interviews that rarely they will find a resident soiled. Staff stated that when they do find a resident with soiled clothing, they will immediately assist the resident. Staff stated that some residents can get soiled quickly due to the medications that residents take. Administrator stated in interviews that this rarely happens, when staff find a resident soiled they immediately notify management and change the resident. 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

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Mai Thao	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2022

LIC9099 (FAS) - (06/04)

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