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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 317005428
Report Date: 02/16/2023
Date Signed: 02/16/2023 02:39:16 PM

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
08/31/2022 and conducted by Evaluator DeAnna Williams-Lyons
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20220831155009
FACILITY NAME:ATRIA ROCKLINFACILITY NUMBER:
317005428
ADMINISTRATOR:DANA STANSELFACILITY TYPE:
740
ADDRESS:3201 SANTA FE WAYTELEPHONE:
(916) 435-8800
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY:105CENSUS: DATE:
02/16/2023
UNANNOUNCEDTIME BEGAN:
01:14 PM
MET WITH:Dana Stansel, Executive DirectorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility staff did not ensure that bedridden resident's meals were within their reach.
INVESTIGATION FINDINGS:
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On February 16 2023, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived unannounced to deliver the findings for complaint #25-AS-20220831155009. LPA met with Dana Stansel, Executive Director, and informed her the reason for the visit. Prior to the visit, LPA completed the required COVID-19 testing protocols, a daily self-screening questionnaire for symptoms of COVID-19; and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and wore a mask for Personal Protective Equipment (PPE).

On January 24 and 25, 2023, LPA reviewed facility documents, and interviewed 5 residents and 8 staff regarding Facility staff did not ensure that bedridden resident's meals were within their reach. All residents stated that it could have happened. They stated they have seen it happen before but not too many times. The staff stated it is a possibility and they too have seen it happen. One staff stated they saw it happen but found out afterwards the resident had pushed the meal away because they were not hungry at that time. LPA could not determine whether staff ensured meals were within resident’s reach or not. The allegation is deemed UNSUBSTANTIATED, meaning although the allegation might have happened or is valid, the preponderance of evidence standards hasn’t been met.
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: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023
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 5
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
08/31/2022 and conducted by Evaluator DeAnna Williams-Lyons
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20220831155009

FACILITY NAME:ATRIA ROCKLINFACILITY NUMBER:
317005428
ADMINISTRATOR:DANA STANSELFACILITY TYPE:
740
ADDRESS:3201 SANTA FE WAYTELEPHONE:
(916) 435-8800
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY:105CENSUS: DATE:
02/16/2023
UNANNOUNCEDTIME BEGAN:
01:14 PM
MET WITH:Dana Stansel, Executive DirectorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility staff did not properly dispose of dirty diapers from resident's room.
Facility did not have sufficient staff to meet resident's needs.
Facility staff left resident unattended for an extended period of time with no food, change of diaper, or change of bedding.
INVESTIGATION FINDINGS:
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LPA investigated the allegation that Facility staff did not properly dispose of dirty diapers from resident's room. Interviews with staff revealed that resident’s rooms are cleaned once a week and then on an as needed basis. The staff protocol is to check the resident every two hours. Staff stated soiled adult briefs are taken to a waste bin by the entrance to the room and forget to throw the soiled briefs away when they left the room. Several hours could potentially elapse before staff would remember the soiled briefs needed to be disposed of therefore a family brought a diaper pale/trash can for the resident’ so the room would not smell.

Based on LPA’s interviews which were conducted and recorded the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED.

To continue see 9099-C...
Substantiated
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: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 25-AS-20220831155009
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: ATRIA ROCKLIN
FACILITY NUMBER: 317005428
VISIT DATE: 02/16/2023
NARRATIVE
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The allegation that the facility did not have sufficient staff to meet the resident’s needs, due to Covid 19, the facility was short staff during several shifts. Interviews revealed that although a staffing Agency was used, the facility still had a difficult time meeting the resident’s needs. Throughout the course of the investigation, staff indicated concerns to CCL and stated management was informed about not having enough caregivers during each shift to meet the needs of the residents. Staff indicated that due to being short staffed, staff were unable to provide proper care to the residents. Staff reported that they postponed showering the residents and providing basic hygiene because they are busy supervising the residents and do not have time during their shift to complete these tasks. Staff and residents reported that they try to ensure the resident’s needs are being met but it gets difficult when they were short staffed.

Based on LPA’s interviews which were conducted and recorded the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED.

The allegation that the facility did not have sufficient staff to meet the resident’s needs, due to Covid 19, the facility was short staff during several shifts. Interviews revealed that although a staffing Agency was used, the facility still had a difficult time meeting the resident’s needs. Throughout the course of the investigation, staff indicated concerns to CCL and stated management was informed about not having enough caregivers during each shift to meet the needs of the residents. Staff indicated that due to being short staffed, staff were unable to provide proper care to the residents. Staff reported that they postponed showering the residents and providing basic hygiene because they are busy supervising the residents and do not have time during their shift to complete these tasks. Staff and residents reported that they try to ensure the resident’s needs are being met but it gets difficult when they were short staffed.

Based on LPA’s interviews which were conducted and recorded the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED.

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: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 25-AS-20220831155009
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: ATRIA ROCKLIN
FACILITY NUMBER: 317005428
VISIT DATE: 02/16/2023
NARRATIVE
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C2...

The allegation that Facility staff left resident unattended for an extended period of time with no food, change of diaper, or change of bedding; During interviews with staff, throughout the course of the investigation LPA was told that it was impossible that it could happen, however, the family installed a camera proving it did happen. No staff entered the resident’s room from 4pm to 8am the next morning.

Based on this information CCL finds the allegations to be SUBSTANTIATED - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

California Code of Regulations, (Title 22, Division & Chapter Number), are being cited on the attached LIC 9099-D.



An exit interview was conducted; appeal rights given, and Plan(s) of Correction were discussed.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-LyonsTELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 25-AS-20220831155009
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: ATRIA ROCKLIN
FACILITY NUMBER: 317005428
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
02/16/2023
Section Cited
CCR
87411(a)
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87411 Personnel Requirements - General
(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required [...]
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The licensee will submit a plan of how staff levels will be maintained to ensure that residents needs are met at all times. Licensee to create, utilize, and retain a document that ensures residents are being observed regularly to ensure their needs are met.
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This requirement was not met as evidenced by: interviews and document review. The licensee failed to comply with the regulation referenced above. Documents reviewed and interviews with staff reveal that staff was not sufficient in numbers to meet the needs of residents. This poses a potential health and safety risk to residents in care.
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Plan of correction due to CCL by 03/16/2023.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-LyonsTELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5