342700472-6-7-2021-27-AS-MSEY-C3TP2U-20210609105631

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700472
Report Date: 06/07/2021
Date Signed: 06/07/2021 11:54:20 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
12/31/2020 and conducted by Evaluator Donna Gurriere

COMPLAINT CONTROL NUMBER: 27-AS-20201231110109

FACILITY NAME:	VILLAS AT STANFORD RANCH, THE		FACILITY NUMBER:	342700472
ADMINISTRATOR:	TYNES, GRAYSON		FACILITY TYPE:	740
ADDRESS:	1430 W STANFORD RANCH RD		TELEPHONE:	(916) 741-7050
CITY:	ROCKLIN	STATE: CA	ZIP CODE:	95765
CAPACITY:	150	CENSUS: 77	DATE:	06/07/2021
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	GRAYSON TYNES, ADMINISTRATOR		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility staff are not meeting the needs of a resident.

INVESTIGATION FINDINGS:

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Donna Gurriere, Licensing Program Analyst (LPA) was in contact with Grayson Tynes, Administrator. It was alleged that the Facility staff are not meeting the needs of a resident.
An investigation was conducted and the administrator, three staff persons, and three residents were interviewed. Documents that were obtained included the resident’s Physician’s Report, Admission Agreement, Preplacement Appraisal, Narrative Charting Notes and a Medications List.

During the interview process, it was reported that staff persons provided care and supervision to include bathing, redirection, getting dressed, activities, grooming, toileting, meals, and medications. It was reported that the resident’s wife assisted at times with the needs of her husband; however, overall, the care providers reported that they completed the majority of the care and supervision tasks.
Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred, and the findings are Unsubstantiated.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (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)

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