<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455002346
Report Date: 05/21/2024
Date Signed: 05/21/2024 10:40:24 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
03/04/2024 and conducted by Evaluator Ivan Avila
COMPLAINT CONTROL NUMBER: 59-AS-20240304082911
FACILITY NAME:NORTH RESIDENTIALFACILITY NUMBER:
455002346
ADMINISTRATOR:DAVIS, CINDYFACILITY TYPE:
735
ADDRESS:1290 MISTLETOE LANETELEPHONE:
(530) 605-0323
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY:6CENSUS: 6DATE:
05/21/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Tim WatsonTIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not conduct a proper fire drill with clients in care
Staff spoke inappropriately to client in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 05/21/2024 Licensing Program Analyst (LPA) Ivan Avila conducted an unannounced complaint investigation visit regarding the above allegations directed by the Department. LPA Avila met with Administrator Tim Watson and explained the purpose of the visit.

During the investigation process, interviews and a records review were initiated.

LPA investigated the allegation, “Staff did not conduct a proper file drill.” Based on interviews conducted and records reviewed, staff followed the facilities evacuation procedures during the fire drill. Fire drills are held once a month randomly during daytime hours and they are performed when clients are home. Clients are encouraged to participate to simulate a real life fire. LPA reviewed the facilities fire drill log, and no errors were observed.

Continued on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
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-20240304082911
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: NORTH RESIDENTIAL
FACILITY NUMBER: 455002346
VISIT DATE: 05/21/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA investigated the allegation, “Staff spoke inappropriately to client in care.” Based on interviews conducted staff were conducting a fire drill on 03/01/2024 and S2 simulated a fire that required all clients to evacuate the facility. During the fire drill an alarm was set off and staff knocked on everyone’s door shouting, “Fire! Fire! Everyone go outside!” The shouting could have been perceived that S2 was yelling at clients and guests but the intent was to direct everyone in the facility to safely evacuate the home as the alarm was loud and sounding off. S2 had to raise her voice to yell over the alarm so everyone could hear her to exit the facility during the fire drill.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview was conducted a copy of the report and appeal rights were provided.

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2