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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 315920040
Report Date: 10/08/2025
Date Signed: 10/08/2025 11:10:06 AM

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
09/02/2025 and conducted by Evaluator Cassandra Mikkelson
COMPLAINT CONTROL NUMBER: 59-AS-20250902172728
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:
10/08/2025
UNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Alexis ThackerTIME COMPLETED:
11:20 AM
ALLEGATION(S):
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Staff are not following resident's care plan.
Staff did not notify resident's responsible party of resident leaving the facility.
INVESTIGATION FINDINGS:
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Licensed Program Analyst (LPA) Cassandra Mikkelson arrived at the facility unannounced and met with Alexis Thacker 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: 10/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025
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-20250902172728
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: 10/08/2025
NARRATIVE
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Staff are not following resident's care plan

Records reviewed indicated that staff were following Resident R1’s care plan. R1 was always accompanied by a family member or friend when leaving the community as it stated in R1’s LIC602A that R1 is “unable to leave the facility unassisted”. Interviews conducted with staff and facility management indicated that R1 was fairly independent and able to be directed by verbal queues to help with daily tasks. Therefore, the allegation staff are not following resident’s care plan is unfounded.

Staff did not notify resident's responsible party of resident leaving the facility

Records reviewed indicated that Resident R1’s responsible party was changed through new power of attorney (POA) paperwork which was given to the facility. Staff followed proper protocols based on the paperwork that was received from R1’s new POA. Interviews conducted with facility management and staff indicated that R1 had been requesting to “go home” when R1’s family and friends were present at the facility. Facility staff called R1’s spouse as a curtesy as they were no longer the POA and the new POA was aware of R1 moving from the facility. Therefore, the allegation staff did not notify resident’s responsible party of resident leaving the facility is unfounded.

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 Administrator. Copy of report was given to facility.

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

DATE: 10/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2