455002190-11-5-2020-25-AS-RLBN-BV52FF-20201106162128

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 455002190
Report Date: 11/05/2020
Date Signed: 11/05/2020 02:54:43 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASETT RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/24/2020 and conducted by Evaluator Misty Valencia

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20200624113331

FACILITY NAME:	SIERRA OAKS OF REDDING		FACILITY NUMBER:	455002190
ADMINISTRATOR:	BOBAN KRISTINE		FACILITY TYPE:	740
ADDRESS:	1580 COLLYER DR		TELEPHONE:	(530) 241-5100
CITY:	REDDING	STATE: CA	ZIP CODE:	96003
CAPACITY:	85	CENSUS:	DATE:	11/05/2020
		UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Kristine Boban, Administrator		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Facility is in disrepair.

INVESTIGATION FINDINGS:

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Misty Valencia, Licensing Program Analyst (LPA) conducted an unannounced complaint phone call and spoke with Kristine Boban, Administrator regarding Allegations above.

Facilities is in disrepair-unsubstantiated

Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2020

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 4

Control Number 25-AS-20200624113331

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASETT RD., STE. 170
CHICO, CA 95926

FACILITY NAME: SIERRA OAKS OF REDDING	FACILITY NUMBER: 455002190
	VISIT DATE: 11/05/2020

NARRATIVE

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LPA observed the facilities "Individual Alert Report" for Resident 1 (R-1) for the period of June 1, 2020- June 30, 2020. LPA observed multiple calls were consistently made from the resident's pendant and/or pull cord during that time period LPA determined that R-1 utilizes both a pendant and/or pull cord. LPA interviewed R-1, who reported that he has 2 (bedroom/bathroom) pull cords and a push button alarm necklace. R-1 reported he always wears a call pendant and states that he can push pendant with no issues. R-1 reports that sometimes staff take a long time when he needs help. LPA reviewed R-1’s alert report that indicated there are times he waits longer than 10 minutes. Through interviews and documentation, there is nothing in facility policies that a time limit is expected to help a resident. The only expectation is for staff to get to residents in a timely manner. LPA was able to determine that R-1 always had some type of alert device available and was always assisted in a timely manner.

The preponderance of evidence standard has not been met. The allegation is Unsubstantiated.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted with Kris Boban, Administrator, via telephone and a copy of this report, dated July 23, 2020 has been provided to via email and an electronic email read receipt confirms receiving this document.

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2020

LIC9099 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASETT RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/24/2020 and conducted by Evaluator Misty Valencia

COMPLAINT CONTROL NUMBER: 25-AS-20200624113331

FACILITY NAME:	SIERRA OAKS OF REDDING		FACILITY NUMBER:	455002190
ADMINISTRATOR:	BOBAN KRISTINE		FACILITY TYPE:	740
ADDRESS:	1580 COLLYER DR		TELEPHONE:	(530) 241-5100
CITY:	REDDING	STATE: CA	ZIP CODE:	96003
CAPACITY:	85	CENSUS:	DATE:	11/05/2020
		UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Kristine Boban, Administrator		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Lack of Care and Supervision.

INVESTIGATION FINDINGS:

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Misty Valencia, Licensing Program Analyst (LPA) conducted an unannounced complaint phone call and spoke with Kristine Boban, Administrator regarding Allegations above.

Lack of care and supervision-substantiated

continued on 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 25-AS-20200624113331

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASETT RD., STE. 170
CHICO, CA 95926

FACILITY NAME: SIERRA OAKS OF REDDING	FACILITY NUMBER: 455002190
	VISIT DATE: 11/05/2020

NARRATIVE

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LPA Interviewed residents and staff. Residents indicate they are all taken care of except R-1 who reported that he has missed at least 6 showers in the past 3 months that he can remember. LPA interview staff who reports that they always try to shower all the residents on their bathing schedules, but some resident refuse due to illness or just not in the mood for a bath that day. LPA reviewed R-1’s shower log for April, May and June. Shower log confirmed that R-1 missed 3 shower days in April, 5 shower days in May and 2 shower days in June. LPA also received text messages between staff and Administrator confirming that the baths were completed, but someone forgot to log them on the shower log. Administrator reported to the staff member that “if it’s not logged on the shower log then it didn’t happen. Staff responded that she apologized and will make sure that it is logged in from now on.” LPA confirmed that R-1 did not receive his schedule showers, therefor the allegation in substantiated.

The preponderance of evidence standard has been met. The allegation is Substantiated.

Based on the interviews and evidence obtained, the preponderance of evidence standard has been met, therefore, the above allegation is found to be substantiated. Due to Covid 19 Pandemic California Code of Regulations, (Title 22), is not being cited at this time. LPA completed a LIC 9102 Technical Assistance.

An exit interview was conducted with Kris Boban, Administrator, via telephone and a copy of this report, dated July 23, 2020 has been provided to via email and an electronic email read receipt confirms receiving this document

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2020

LIC9099 (FAS) - (06/04)

Page: 4 of 4