455002333-12-2-2021-25-AS-RLBN-C9HPVC-20211208103853

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 455002333
Report Date: 12/02/2021
Date Signed: 12/02/2021 10:19:54 PM

Unsubstantiated

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
09/08/2021 and conducted by Evaluator Misty Valencia

COMPLAINT CONTROL NUMBER: 25-AS-20210908110256

FACILITY NAME:	PLATINUM HOME		FACILITY NUMBER:	455002333
ADMINISTRATOR:	ZUMKEHR, ERIC		FACILITY TYPE:	735
ADDRESS:	7279 PLATINUM WAY		TELEPHONE:	(530) 247-0852
CITY:	REDDING	STATE: CA	ZIP CODE:	96001
CAPACITY:	3	CENSUS: 3	DATE:	12/02/2021
		UNANNOUNCED	TIME BEGAN:	12:10 PM
MET WITH:	Eric Zumkehr, Administrator		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Facility is dirty
Residents are not safe

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA's) Misty Valencia conducted an unannounced complaint investigation visit to deliver findings regarding the above allegations and met with Eric Zumkehr, Administrator. 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 staff

continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Misty Valencia
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021

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-20210908110256

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: PLATINUM HOME	FACILITY NUMBER: 455002333
	VISIT DATE: 12/02/2021

NARRATIVE

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Facility is dirty

LPA investigated the allegation; Facility is dirty and determined it to be unsubstantiated. LPA toured the facility and during the visit, LPA Valencia walked through three (3) resident rooms to check for unsanitary conditions and dirty floors. Rooms were in standard or fair condition, i.e. floors were clean, counters and night stands were a bit dusty, and minimal garbage in the trash cans. LPA toured the dining area, where the floors were cleaned with no trip or safety hazards and there is no odors. LPA interviewed three of three (3 of 3) residents who all reported they have no dirty or unsanitary issues in the facility. LPA interview three of three (3 of 3) staff members who all agreed that the facility could use a little dusting, but other than that there are no issues. It was stated that at times residents do not want staff to clean their rooms, but then the residents are encouraged to clean their rooms. As a result of this investigation, LPA finds the allegations that facility is dirty, UNSUBSTANTIATED.

Residents are not safe

LPA investigated the allegation; Residents are not safe and determined it to be unsubstantiated. LPA toured the facility and during the visit, LPA interviewed three of three (3 of 3) residents who all reported they have no concerns or safety issues in the facility. LPA interview three of three (3 of 3) staff members who all agreed that the facility has never heard or witnessed any safety issues or concerns. As a result of this investigation, LPA finds the allegations that Residents are not safe, UNSUBSTANTIATED.

A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

There were no citations issued during today's visit, copy of report was given. An exit interview was conducted

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Misty Valencia
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021

LIC9099 (FAS) - (06/04)

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