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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700472
Report Date: 06/07/2021
Date Signed: 06/07/2021 12:01:06 PM



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
08/04/2020 and conducted by Evaluator Donna Gurriere
COMPLAINT CONTROL NUMBER: 27-AS-20200804160444
FACILITY NAME:VILLAS AT STANFORD RANCH, THEFACILITY NUMBER:
342700472
ADMINISTRATOR:TYNES, GRAYSONFACILITY TYPE:
740
ADDRESS:1430 W STANFORD RANCH RDTELEPHONE:
(916) 741-7050
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY:150CENSUS: DATE:
06/07/2021
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:GRAYSON TYNESTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff are not meeting the resident’s needs.
Staff are not cleaning resident rooms.
INVESTIGATION FINDINGS:
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Donna Gurriere, Licensing Program Analyst (LPA) was in contact with Grayson Tynes, Administrator. It was alleged that during the month of August 2020, Staff were not meeting the resident’s needs and Staff were not cleaning resident rooms.

An investigation was conducted and the administrator and four staff persons were interviewed. Randomly, three residents were chosen for interviews and their files were reviewed. Documents that were obtained, included the Physician’s Report, the Resident Assessment and the Needs and Service Plans. One resident was available for an interview, one resident was not interviewed as the Physician’s Report indicated that she had confusion and one resident is no longer residing at the facility.


**continued**
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Rayna L BrysonTELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021
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 3
Control Number 27-AS-20200804160444
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: VILLAS AT STANFORD RANCH, THE
FACILITY NUMBER: 342700472
VISIT DATE: 06/07/2021
NARRATIVE
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**continued**


Staff are not meeting the resident’s needs.
It was alleged that staff were not providing needs to the residents to include hydration. Staff persons and a resident were interviewed, and they reported that hydration is provided. Examples of hydration included that the dining room is open from 7:00 a.m. to 7:00 p.m. and always has fluids and refreshments available, a Bistro area provides water, juice, coffee and other drinks during the daytime, plus snacks, each resident’s apartment has a sink and refrigerator to supply water or cold drinks and staff persons are cuing and encouraging residents to have fluids. The facilities hydration policy states “Offer resident beverage of choice mid-morning, mid-afternoon and evening, in addition to mealtimes.” The overall senses was that hydration is provided to the residents.

It was alleged that staff did not provide assistance with the cleanliness of the residents. Staff and a resident were interviewed and it was reported that service plans are being executed daily, that there is assistance with daily living to include toileting, addressing incontinence issues, medication management, showering, getting dressed, encouraging hydration, standby assistance and escorting as needed to the dining area. The overall senses were that staff did provide assistance with the cleanliness of the residents.





**continued**
SUPERVISOR'S NAME: Rayna L BrysonTELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 27-AS-20200804160444
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: VILLAS AT STANFORD RANCH, THE
FACILITY NUMBER: 342700472
VISIT DATE: 06/07/2021
NARRATIVE
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**continued**


Staff are not cleaning resident rooms.
Staff and a resident indicated that there are housekeeping services provided weekly to include changing sheets, dusting, vacuuming, laundry, cleaning food debris from the room and carpets, and removing trash. It was reported that during the week if any of the rooms need additional cleaning prior to the cleaning day, the staff will clean daily to include laundry, sheet washing, trash take out, tiding up and debris clean up. It was overall felt that the staff persons keep up on the cleaning of the resident rooms.

Based on the information obtained and interviews conducted, the above allegations are Unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are Unsubstantiated.
SUPERVISOR'S NAME: Rayna L BrysonTELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3