455002191-5-12-2022-25-AS-KHOS-CEGPGH-20220516111821

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 455002191
Report Date: 05/12/2022
Date Signed: 05/12/2022 03:13:12 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/15/2022 and conducted by Evaluator Misty Valencia

COMPLAINT CONTROL NUMBER: 25-AS-20220215125032

FACILITY NAME:	SIERRA OAKS OF REDDING MEMORY CARE		FACILITY NUMBER:	455002191
ADMINISTRATOR:	BOBAN, KRISTINE		FACILITY TYPE:	740
ADDRESS:	1620 COLLYER DR		TELEPHONE:	(530) 241-5100
CITY:	REDDING	STATE: CA	ZIP CODE:	96003
CAPACITY:	0	CENSUS: 68	DATE:	05/12/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Kristina Boban, Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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INVESTIGATION FINDINGS:

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On 05/12/2022, Licensing Program Analyst (LPA) Misty Valencia conducted an unannounced complaint investigation visit regarding the above allegations and met with Kristina Boban, Administrator (Admin). Prior to initiating the complaint visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted Administrator 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 Administrator (Admin) Kristine Boban.

continued on 9099-C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

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-20220215125032

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 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: SIERRA OAKS OF REDDING MEMORY CARE	FACILITY NUMBER: 455002191
	VISIT DATE: 05/12/2022

NARRATIVE

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Facility has a scabies breakout
Staff did not notify responsible party of scabies outbreak at facility
Facility not maintained clean and sanitary
Resident sustained wounds while in care
Staff did not follow resident's physician's order

Interviews conducted with Administrator, residents, staff and records reviewed regarding allegations and confirmed that there was not an outbreak of scabies at the facility, therefore a notification would not have been needed. Admin provided documentation that residents were examined and there was no diagnosis of scabies at the facility. LPA also toured the facility and found facility to be clean, sanitary, and free from odors. LPA was not able to interview the reporting party regarding sustaining wounds while in care or not following resident’s physicians’ orders to confirm weather the physicians’ orders were not being followed. Admin admitted that if any residents receive wounds that needs attention they are treat with first aid, or sent out to the pyhsicians office to be treated. R1 was moved from the facility after complaint was made, therefore LPA was not able to interview R1. LPA reviewed R1's physicians report and medical records, which did not indicate any wounds or physician’s order were not being followed.

Based on information gathered, LPA finds the allegations to be UNFOUNDED- A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

An exit interview was conducted. and copy of report provided to facility.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

LIC9099 (FAS) - (06/04)

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