455002027-6-18-2024-59-AS-KHOS-D6FUHS-20240621153625

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 455002027
Report Date: 06/18/2024
Date Signed: 06/18/2024 09:36:39 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/12/2024 and conducted by Evaluator Donna Gurriere

COMPLAINT CONTROL NUMBER: 59-AS-20240312155426

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: 22	DATE:	06/18/2024
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	NATASHA PEERMAN		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staff drugged resident in care.
Staff smoke marijuana in the facility premises.
Staff locked resident in care.
Staff mismanaged resident's medication.
Centrally stored medications are made accessible to residents in care.
Staff are not following proper reporting requirements.
Staff do not provide adequate supervision to residents in care.

INVESTIGATION FINDINGS:

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On 06/18/24 Donna Gurriere, Licensing Program Analyst (LPA) arrived at the facility unannounced to deliver final findings regarding a complaint that was received on 03/12/24. LPA Gurriere met with , Natasha Peerman, Asst. Administrator, and explained the purpose of the visit.

Staff drugged resident in care.
Staff smoke marijuana in the facility premises.
Staff locked resident in care.
Staff mismanaged resident's medication.
Centrally stored medications are made accessible to residents in care.
Staff are not following proper reporting requirements.
Staff do not provide adequate supervision to residents in care.

continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024

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 59-AS-20240312155426

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: LAVENDER HILLS ASSISTED LIVING II	FACILITY NUMBER: 455002027
	VISIT DATE: 06/18/2024

NARRATIVE

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During the interview process, the administrator and six staff persons were interviewed. Two staff persons were no longer working at the facility; however, they were still interviewed. The facility is a memory care unit; thus, the residents were not interviewed. Contact information received, included staff telephone numbers and staff work schedule.

During the investigation process, it was noted that many of the allegations are in relation to specific residents; however, the names of the residents were not provided and therefore the allegations could not be thoroughly explored. Overall, it was reported that the staff were not familiar with the allegations alleged. It is noted that the exact same allegations were stated for the sister facility.

Although the above allegations mentioned may have happened, or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and all of the above findings are Unsubstantiated.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024

LIC9099 (FAS) - (06/04)

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