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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 312700574
Report Date: 12/20/2022
Date Signed: 12/20/2022 11:32:56 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
07/06/2022 and conducted by Evaluator DeAnna Williams-Lyons
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20220706101357
FACILITY NAME:ANSEL PARK SENIOR LIVING COMMUNITYFACILITY NUMBER:
312700574
ADMINISTRATOR:JAMES STACYFACILITY TYPE:
740
ADDRESS:1200 ORCHID DRIVETELEPHONE:
(916) 250-0770
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY:100CENSUS: 79DATE:
12/20/2022
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Deborah Taylor, Executive DirectorTIME COMPLETED:
11:55 AM
ALLEGATION(S):
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Facility has insufficient staffing to meet resident needs

Facility is retaining residents that require a higher level of care
INVESTIGATION FINDINGS:
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On December 20, 2022, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived to deliver findings for complaint #25-AS-20220706101357. LPA met with Deborah Taylor and informed her the reason for the visit. Prior to initiating 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 and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and wore a N-95 mask for Personal Protective Equipment.

Community Care Licensing received a complaint alleging facility has insufficient staffing to meet residents needs and facility is retaining residents that need a higher level of care. LPA reviewed facility documentation and conducted interviews.

To continue see 9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-LyonsTELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022
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 3
Control Number 25-AS-20220706101357
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: ANSEL PARK SENIOR LIVING COMMUNITY
FACILITY NUMBER: 312700574
VISIT DATE: 12/20/2022
NARRATIVE
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Facility has insufficient staffing to meet residents needs
LPA investigated allegation that facility has, "Insufficient staffing". LPA interviewed 4 residents, 4 staff, and reviewed facility documentation. LPA interviewed staff in which they stated AM shift has 3 caregivers and 1 medical technicians, PM shift has 2 to 3 caregivers and 2 medical technicians , and NOC shift has 2 caregivers and 1 medical technicians on the floor. Care staff indicated that due to Covid related issues, at times it was hard finding staff to hire. Facility used a caregiver agency to supplement care when they were shorthanded. Two care staff indicated they are able to meet residents needs with the staffing that is available. LPA interviewed residents in care, in which two of four stated staffing levels have improved over the last several months. Residents indicated that facility provided a caregiver agency to supplement staffing levels. Two of the four residents indicated too many times they are waiting long periods of time for staff to respond to pendant pushes and showers were eventually cancelled. Relevant party indicated there is insufficient staffing to meet the needs of the residents. Due to the information obtained, 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.

Facility is retaining residents that need a higher level of care
During the investigation, LPA conducted interviews and reviewed documentation pertinent to the investigation. One staff interviewed stated it may appear that residents are retained needing a higher level of care, however these resident’s health condition decreased since they were admitted and may now need more care. Usually, the resident will go to the hospital and return on hospice. Eventually they will need more care because they can no longer do the activities they used to do, therefore, needing more care. Another witness interviewed stated; Pendants are not being reset once staff are attending to the resident. This makes it look like either staff are not checking on the resident when they have pulled their pendant, or they have been waiting for a very long time for help. The facility also have staff in memory care unit to add to the staffing. During investigation visit conducted on 11/30/2022, LPA review facility files. During this review, LPA did not observe any prohibited health conditions with any of the residents receiving care, or previously receiving care, at the facility. The facility’s daily activities do not appear to need additional staff than what the facility already have.

To continue see 9099-C2...
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-LyonsTELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 25-AS-20220706101357
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: ANSEL PARK SENIOR LIVING COMMUNITY
FACILITY NUMBER: 312700574
VISIT DATE: 12/20/2022
NARRATIVE
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9099-C2...

Based on interviews conducted and records reviewed, the preponderance of evidence standards has not been met. Therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
Per California Code of Regulations, Title 22, no citations were issued.

An exit interview was conducted, and a copy of this report was given to Deborah Taylor.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-LyonsTELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3