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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700511
Report Date: 02/28/2023
Date Signed: 02/28/2023 05:54:27 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
01/12/2023 and conducted by Evaluator Cassie Yang
COMPLAINT CONTROL NUMBER: 25-AS-20230112090928
FACILITY NAME:GOLDEN RETREAT SENIOR LIVING 2FACILITY NUMBER:
342700511
ADMINISTRATOR:HOLMQUIST, TRAVIS CFACILITY TYPE:
740
ADDRESS:3431 PALESTINE LNTELEPHONE:
(916) 283-4257
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: DATE:
02/28/2023
UNANNOUNCEDTIME BEGAN:
05:00 PM
MET WITH:TIME COMPLETED:
06:10 PM
ALLEGATION(S):
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Staff sexually assaulted resident while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cassie Yang arrived at the facility unannounced to deliver complaint finding. LPA met with Yoda Rhonda and explained the purpose of the visit. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask.

After intensive interviews conducted by the Department, the investigation found that R1 has been inconsistent in multiple interviews regarding the place and duration of the alleged assault. The investigation found R1 has been experiencing short term memory loss and cognitive issues.

Additionally, the investigation found R1 had alleged hearing S1 unzipping his pants but the Department was informed staff wears medical scrubs at the facility which do not have zippers. Additional staff and residents were interviewed, and denied observing any inappropriate interactions between R1 and S1.

Please continue on LIC 9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: 916-201-1928
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2023
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 2
Control Number 25-AS-20230112090928
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: GOLDEN RETREAT SENIOR LIVING 2
FACILITY NUMBER: 342700511
VISIT DATE: 02/28/2023
NARRATIVE
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As a result of this investigation, the Department finds allegation to be (US) Unsubstantiated - A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview conducted and a copy of the report and appeal rights was provided.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: 916-201-1928
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2