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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455002333
Report Date: 11/14/2023
Date Signed: 11/14/2023 02:50:28 PM

Substantiated


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
10/20/2023 and conducted by Evaluator Jaynae Boyles
COMPLAINT CONTROL NUMBER: 59-AS-20231020161333
FACILITY NAME:PLATINUM HOMEFACILITY NUMBER:
455002333
ADMINISTRATOR:ZUMKEHR, ERICFACILITY TYPE:
735
ADDRESS:7279 PLATINUM WAYTELEPHONE:
(530) 247-0852
CITY:REDDINGSTATE: CAZIP CODE:
96001
CAPACITY:3CENSUS: 3DATE:
11/14/2023
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Adminstrator- Cameron Olson TIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility fence is in disrepair.
INVESTIGATION FINDINGS:
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On 11/14/23 Licensing Program Analyst Jaynae Boyles made an unannounced visit to the facility and met with Administrator Cameron Olson. The purpose of this visit was to deliver the results of a complaint investigation.
During the course of the investigation the administrator was interviewed. LPA reviewed the following documents: email correspondence with the property manager and ISP services. The administrator stated that the fence has been broken for many months and there have been challenges with getting the fence replaced, however it is required that the facility remain in good repair and the facility was without a fence for 8-10 months.

Based on interviews and evidence obtained during the investigation, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22), is being cited on the attached LIC9099D. Appeal rights were provided. An exit interview was conducted. A copy of the report was provided to administrator Cameron Olsen
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Jaynae Boyles
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2023
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 2
Control Number 59-AS-20231020161333
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: PLATINUM HOME
FACILITY NUMBER: 455002333
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/14/2023
Section Cited
CCR
80087(a)
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80087 Buildings and Grounds
The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.
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Licensee shall repair the fence in the backyard
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Licensee failed based on not repairing the backyard fence for an extended time.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Jaynae Boyles
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2