455002027-10-25-2022-25-AS-MSEY-CKLUWJ-20221027155646

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 455002027
Report Date: 10/25/2022
Date Signed: 10/25/2022 03:57:27 PM

Unfounded

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
06/17/2022 and conducted by Evaluator Shannon Diegoruelas

COMPLAINT CONTROL NUMBER: 25-AS-20220617135448

FACILITY NAME:	LAVENDER HILLS ASSISTED LIVING II		FACILITY NUMBER:	455002027
ADMINISTRATOR:	BOSS, JENNIFER		FACILITY TYPE:	740
ADDRESS:	1750 COLLYER DRIVE		TELEPHONE:	(530) 247-0749
CITY:	REDDING	STATE: CA	ZIP CODE:	96003
CAPACITY:	25	CENSUS: 18	DATE:	10/25/2022
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Naitasha Peerman, Administrative Assistant		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Illegal eviction.
Personal rights.

INVESTIGATION FINDINGS:

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10/25/2022 Licensing Program Analyst (LPA) Shannon Diegoruelas, arrived at the facility unannounced to deliver findings for a complaint investigation for the above allegations. LPA met with Naitasha Peerman, Administrative Assistant and explained the purpose of the visit. Prior to initiating the visit, LPA completed required COVID-19 daily self-screening for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA contacted facility and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical mask. Additionally, LPA was screened by facility staff.

Continued 9099-C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Shannon Diegoruelas	TELEPHONE: (530) 282-2393
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

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-20220617135448

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: LAVENDER HILLS ASSISTED LIVING II	FACILITY NUMBER: 455002027
	VISIT DATE: 10/25/2022

NARRATIVE

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Illegal eviction.
Personal rights.

It has been determined regarding the above allegations from record review and through correspondence from facility, the facility communicated with R1's authorized representative in a timely and appropriate manner and provided R1 every reasonable opportunity to return to the facility from the hospital. Facility stated they never refused to take R1 back or issued any form of eviction, on 06/16/2022 the authorized representative was simply made aware, that due to R1’s rapidly declining condition at the hospital, and facility being non-medical, that R1 would either have to be stabilized at a rehabilitation facility or return to facility on hospice, as the hospital already said R1 qualified. Authorized representative agreed to hospice and then later declined after R1 was already back at the facility. On 06/17/2022 because R1 was not on hospice R1 had to be sent back to Mercy ER for low O2. Then on 6/20/2022 R1 was signed onto hospice by authorized representative and R1 returned to the facility.

Based on records reviewed to support facility's statement:

-Facility's documentation for R1 from 06/16/2022, 06/17/2022, and 6/20/2022 that coincide with facility's statement.

-Mercy ER's admission and discharge orders for R1 confirmed with the dates the facility stated.

The department has determined that the complaint alleging an illegal eviction and personal rights violation was UNFOUNDED meaning that the allegations were false, could not have happened and/or is without a reasonable basis.

No citations are being issued as a result of today's visit.

Exit interview was conducted and a copy of report was provided to Administrator.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Shannon Diegoruelas	TELEPHONE: (530) 282-2393
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

LIC9099 (FAS) - (06/04)

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