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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 315920040
Report Date: 07/10/2025
Date Signed: 07/10/2025 12:26:10 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
06/26/2025 and conducted by Evaluator Cassandra Mikkelson
COMPLAINT CONTROL NUMBER: 59-AS-20250626150100
FACILITY NAME:SIERRA RIDGE SENIOR LIVINGFACILITY NUMBER:
315920040
ADMINISTRATOR:ALEXIS THACKERFACILITY TYPE:
740
ADDRESS:3265 BLUE OAKS DRIVETELEPHONE:
(530) 718-1553
CITY:AUBURNSTATE: CAZIP CODE:
95602
CAPACITY:65CENSUS: 47DATE:
07/10/2025
UNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Cheya Lovelace, Resident Care DirectorTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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Licensee overcharged resident for services
Staff did not provide resident’s DNR directives to medical personnel
INVESTIGATION FINDINGS:
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Licensed Program Analyst (LPA) Cassandra Mikkelson arrived at the facility unannounced and met with Cheya Lovelace, Resident Care Coordinator to deliver findings for the above complaint allegation.

During the investigation, LPA conducted interviews, conducted a tour of the facility, and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

*** Report continued on 9099-C***
Unfounded
Estimated Days of Completion: 10
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025
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 2
Control Number 59-AS-20250626150100
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: SIERRA RIDGE SENIOR LIVING
FACILITY NUMBER: 315920040
VISIT DATE: 07/10/2025
NARRATIVE
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Licensee overcharged resident for services.

Records reviewed indicated that resident R1 was not charged a pre admission fee of $3000.00 when moving in to the facility. R1 previously resided at a facility that was owned by the licensee. Upon moving into the previous facility, the resident was charged $3000.00 pre-admission fee. When R1 moved into Sierra Ridge, the licensee honored the pre-admission fee R1 paid at the previous facility and did not charge an additional fee upon move in at Sierra Ridge. Based on the information gathered during the complaint investigation, the facility did not overcharge R1 therefore the allegation is UNFOUNDED.

Staff did not provide resident’s DNR directives to medical personnel

Records reviewed indicated that Resident R1 received discharge paperwork from the hospital during a visit on 05/08/2025. At that time, R1 had a “do not resuscitate (DNR)” order on file with the hospital. Facility records indicate that R1 had a Physician’s Order for Living Sustaining Treatment (POLST) form on file that indicated R1 had a DNR order. Interviews conducted indicated that facility sends documents with a resident when they are sent to the hospital, which includes a resident's emergency contact information, birthdate and physician name, current medication list, and POLST/DNR form. Based on interviews conducted and document’s reviewed, the hospital was provided and aware of R1’s POLST and DNR wishes.

Based on records reviewed and interviews, LPA finds the above allegations to be UNFOUNDED- meaning that the allegations were false, could not have happened and/or is without reasonable basis. Exit interview conducted with the Resident Care Coordinator. Copy of report was given to facility.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025
LIC9099 (FAS) - (06/04)
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