045002441-1-26-2023-25-AS-KHOS-CNNPFZ-20230202101734

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 045002441
Report Date: 01/26/2023
Date Signed: 01/26/2023 10:00:41 AM

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
01/17/2023 and conducted by Evaluator Rebecca Knight

COMPLAINT CONTROL NUMBER: 25-AS-20230117154746

FACILITY NAME:	AMBER GROVE PLACE		FACILITY NUMBER:	045002441
ADMINISTRATOR:	CROWLEY, JOHN		FACILITY TYPE:	740
ADDRESS:	3049 ESPLANADE		TELEPHONE:	(530) 826-3226
CITY:	CHICO	STATE: CA	ZIP CODE:	95973
CAPACITY:	70	CENSUS:	DATE:	01/26/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	John Crowley - Executive Director		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staff failed to treat resident with dignity and respect - UNSUBSTANTIATED

INVESTIGATION FINDINGS:

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01/26/2023 9:30 AM Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with Executive Director John Crowley. Prior to initiating the visit, LPA completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 mask, gloves.

During the course of the investigation the executive director, ombudsman and care staff and resident were interviewed.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023

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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Control Number 25-AS-20230117154746

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: AMBER GROVE PLACE	FACILITY NUMBER: 045002441
	VISIT DATE: 01/26/2023

NARRATIVE

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Staff failed to treat resident with dignity and respect - UNSUBSTANTIATED

It was reported that a care staff entered a resident’s room and raised their voice in front of Resident 1 (R1) causing them to feel they were not treated with dignity and respect.

Staff interviews conducted did not indicate that staff have spoken to R1 in a manner that was disrespectful.

Executive Director stated Staff absolutely positively would not treat a resident without dignity and respect.

Ombudsman stated they have never witnessed staff treating R1 disrespectfully or without dignity.

Resident 1 stated they have never had any problems in the way that staff interacts with them and staff treats them respectfully.

It was determined that facility staff treat R1 with dignity and respect. This allegation is unsubstantiated.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are UNSUBSTANTIATED.

An exit interview was conducted. A copy of the report was provided to Executive Director John Crowley.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023

LIC9099 (FAS) - (06/04)

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