<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 317005531
Report Date: 03/04/2022
Date Signed: 03/07/2022 08:00:58 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/17/2021 and conducted by Evaluator Todd Tryon
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20210617143244
FACILITY NAME:SIERRA RIDGE SENIOR LIVINGFACILITY NUMBER:
317005531
ADMINISTRATOR:JOE DUNHAMFACILITY TYPE:
740
ADDRESS:3265 BLUE OAKS DRTELEPHONE:
(530) 887-8600
CITY:AUBURNSTATE: CAZIP CODE:
95602
CAPACITY:65CENSUS: 36DATE:
03/04/2022
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Joe DunhamTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee did not obtain a resident/conservator's statement of voluntary entry or consent to a secure perimeter facility.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 3/4/2022 LPA Tryon visited the facility to complete the complaint. LPA met with Executive Director Joe Dunham. Prior to the visit LPA self-screened to ascertain that I did not have any potential COVID-19 symptoms; and took my temperature. LPA wore a surgical mask to the visit.
On conducting the complaint investigation, LPA has spoken with staff, reviewed documentation, and reviewed Admission paperwork for resident R1. In reviewing the admission agreement and attachments, LPA found that the Responsible Party had signed the Sierra Ridge Memory Care Residence and Care Agreement on behalf of R1; and had also signed the Sierra Ridge Memory Care Delayed Egress and Courtyard Gates Acknowledgement. LPA also noted that there was no signature present from resident R1 herself. Documents were dated 3/11/2020. In reviewing Power of Attorney Documents filed on behalf of R1, it appears that she had appointed the Responsible Party as her Power of Attorney on 9/4/2019. In reviewing the Petition for Temporary Conservatorship filed by the Responsible Party, it was learned that the petition was filed on 8/7/2020. Therefore, at the time that the admission agreement was signed, the responsible party did have Power of Attorney for R1, but did not have a conservatorship for R1. Therefore, the allegation that
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 208-7709
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022
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 6
Control Number 25-AS-20210617143244
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: SIERRA RIDGE SENIOR LIVING
FACILITY NUMBER: 317005531
VISIT DATE: 03/04/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
the licensee did not obtain a resident/conservator’s statement of voluntary entry or consent to a secure facility is SUBSTANTIATED. A finding that the allegation is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

The following deficiency is cited as per Title 22 Regulations. Appeal rights were provided, exit interview conducted.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 208-7709
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 25-AS-20210617143244
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: SIERRA RIDGE SENIOR LIVING
FACILITY NUMBER: 317005531
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/04/2022
Section Cited
CCR
87705(l)(4)(B)
1
2
3
4
5
6
7
The licensee shall maintain either of the following documents in the resident's record at the facility: (a) The conservator's written consent for admission for each resident who has been conserved under the Probate Code or the Lanterman-Petris-Short Act; or (B) A written statement signed by each non-conserved resident... resident voluntarily consents to admission.
1
2
3
4
5
6
7
The facility will ensure that admission documents are signed by a court-appointed conservator or by the resident.

The Administrator will submit a plan of how this requirement will be met. Plan to be submitted by 4/4/2022.
8
9
10
11
12
13
14
This requirement was not met as evidenced by:
Through record review, LPA learned that the resident did not have a court-appointed conservator at the time of initial admission; and the resident’s signature was not obtained on the admission agreement or statement of voluntary entry or consent to a secure facility.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 208-7709
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/17/2021 and conducted by Evaluator Todd Tryon
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20210617143244

FACILITY NAME:SIERRA RIDGE SENIOR LIVINGFACILITY NUMBER:
317005531
ADMINISTRATOR:JOE DUNHAMFACILITY TYPE:
740
ADDRESS:3265 BLUE OAKS DRTELEPHONE:
(530) 887-8600
CITY:AUBURNSTATE: CAZIP CODE:
95602
CAPACITY:65CENSUS: 36DATE:
03/04/2022
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Joe DunhamTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility retained a resident unable to administer her own medication.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 3/4/2022 LPA Tryon arrived at the facility at 2:00 p.m. to continue to work on
the complaint. LPA met with Executive Director Joe Dunham.
During the course of the complaint investigation, LPA has interviewed staff, interviewed
resident, reviewed complaint documents and reviewed Facility Documentation.
Regarding the allegation that the facility retained a resident unable to administer her
own medication, LPA has reviewed documentation, interviewed staff and resident. LPA
learned that although resident R1 may have difficulty swallowing some medications at
some times, she is able to place her medications in her own mouth, either in pill form or
crushed in food such as pudding. Staff assist by dispensing the correct medications,
and crushing and mixing with food if requested, and handing the medications/food to
R1. Therefore, the allegation that the facility retained a resident unable to administer
her own medications is UNFOUNDED.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 208-7709
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/17/2021 and conducted by Evaluator Todd Tryon
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20210617143244

FACILITY NAME:SIERRA RIDGE SENIOR LIVINGFACILITY NUMBER:
317005531
ADMINISTRATOR:JOE DUNHAMFACILITY TYPE:
740
ADDRESS:3265 BLUE OAKS DRTELEPHONE:
(530) 887-8600
CITY:AUBURNSTATE: CAZIP CODE:
95602
CAPACITY:65CENSUS: 36DATE:
03/04/2022
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Joe DunhamTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility retained a resident who depended on others to perform all activities of daily
living.
Staff are concealing a resident’s medications in other substances.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Regarding the allegation that the Facility retained a resident who depended on others to
perform all activities of daily living, LPA has reviewed records, interviewed staff and
resident. LPA learned that although R1 has been capable of doing things for herself
more at some times than at others, she has had some degree of being able to perform
tasks such as feeding herself, assisting with bathing tasks, assisting with toileting,
dressing, placing medications in her own mouth, etc. Therefore, the allegation is
UNFOUNDED.
Regarding the allegation that Staff are concealing a resident’s medications in other
substances, LPA reviewed doctor order from Bristol Hospice signed 3/18/2020 which
states “ok to crush meds, mix in food.” Furthermore, in interviewing staff, LPA learned
that staff do inform R1 that she is being given medications. In fact, they routinely ask
her how she wants to take her medications at that time, either to swallow the pills; or to
have it crushed and mixed into food. Staff indicated that generally in the morning R1
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 208-7709
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 25-AS-20210617143244
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: SIERRA RIDGE SENIOR LIVING
FACILITY NUMBER: 317005531
VISIT DATE: 03/04/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
will ask that the medications be crushed and put in food, as she takes more medications
at that time. Sometimes she requests to simply take the pills at later times, as there are
not as many pills. LPA spoke with R1, and she is aware that her medications are often
given in food, and she is okay with this. Therefore, it appears that the staff are NOT
concealing R1’s medications. The allegation is UNFOUNDED.

A finding that the allegation is Unfounded means that the allegation is false, could not
have happened, and/or is without a reasonable basis.
Exit interview conducted.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 208-7709
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 6