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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 317005531
Report Date: 07/25/2024
Date Signed: 07/25/2024 04:12:22 PM

Substantiated


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
04/19/2024 and conducted by Evaluator Todd Tryon
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20240419111321
FACILITY NAME:SIERRA RIDGE SENIOR LIVINGFACILITY NUMBER:
317005531
ADMINISTRATOR:JENNIFER FUSTONFACILITY TYPE:
740
ADDRESS:3265 BLUE OAKS DRTELEPHONE:
(530) 887-8600
CITY:AUBURNSTATE: CAZIP CODE:
95602
CAPACITY:0CENSUS: 0DATE:
07/25/2024
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Jennifer FustonTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff was physically rough with resident.
INVESTIGATION FINDINGS:
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On 7/25/2024 LPA Tryon visited the facility to deliver findings for the complaint. LPA met with Executive Director Jennifer Fuston.
During the course of the investigation LPA spoke with the Administrator, Resident Services Director, 2 staff who witnessed the alleged incident, and the resident involved.
LPA learned that on 4/4/2024 Staff S1 had attempted to have resident R1 sit down in a dining chair for dinner. R1 was touching dishes on the table and resisting sitting. Staff S1 then pushed down on R1's shoulders to try to get R1 to sit down. R1 said several times "stop you're hurting me!" As R1 sat down, R1 hit elbow on the chair arm. Other staff then moved Staff S1 away from R1 and another staff worked to calm R1. Witnesses stated S1 had appeared more aggressive/forceful than necessary in trying to have R1 sit. Paramedics were contacted and checked R1. No bruises or injuries were noted. Staff S1 was subsequently removed from the facility.
Since it is found that staff S1 did use unneccessary force to get R1 to sit, LPA finds the allegation that staff was physically rough with resident to be SUBSTANTIATED. A finding of Substantiated means that the
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
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-20240419111321
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: 317005531
VISIT DATE: 07/25/2024
NARRATIVE
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the allegation is valid because the preponderance of the evidence standard has been met.
Since the complaint was filed on April 19, 2024 on the PREVIOUS facility license, and the facility is now operating under a new owner and license, NO CITATION IS ISSUED AT THIS TIME.
Appeal rights were provided. Exit interview conducted.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2