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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 317000174
Report Date: 08/21/2024
Date Signed: 08/21/2024 02:37:57 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
08/19/2024 and conducted by Evaluator Todd Tryon
COMPLAINT CONTROL NUMBER: 59-AS-20240819145106
FACILITY NAME:AUBURN RAVINE TERRACEFACILITY NUMBER:
317000174
ADMINISTRATOR:BILL HUNTFACILITY TYPE:
740
ADDRESS:750 AUBURN RAVINE ROADTELEPHONE:
(530) 823-8339
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY:25CENSUS: DATE:
08/21/2024
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:TIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Neglect of Physical Care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 8/21/2024 LPA Tryon visited the facility to open the complaint. LPA met with Assisted Living Supervisor. LPA explained the reason for the visit. Upon speaking with staff, LPA learned that the resident involved with the complaint is NOT a resident of the Assisted Living portion of the facility. That resident lives in skilled nursing; the skilled nursing portion of the facility is NOT regulated by Dept. of Social Services/Community Care Licensing.

Therefore, as the complaint was submitted to the incorrect licensing agency, the complaint is UNFOUNDED for this license. LPA will return the complaint/forward to the correct agency.

Exit interview conducted.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024
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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