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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455002559
Report Date: 12/02/2021
Date Signed: 12/02/2021 10:18:07 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-20210908111844
FACILITY NAME:OAK MESA HOMEFACILITY NUMBER:
455002559
ADMINISTRATOR:BAUGHMAN, LINDSAYFACILITY TYPE:
735
ADDRESS:1870 OAK MESATELEPHONE:
(530) 215-3973
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:6CENSUS: 5DATE:
12/02/2021
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Lindsay Boughman, AdministratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Residents are left alone.
Residents are not getting their needs met.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA's) Misty Valencia and Dawn Keane conducted an unannounced complaint investigation visit to deliver findings regarding the above allegations and met with Lindsay Boughman, 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)
Page: 1 of 2
Control Number 25-AS-20210908111844
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: OAK MESA HOME
FACILITY NUMBER: 455002559
VISIT DATE: 12/02/2021
NARRATIVE
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Residents are left alone

LPA investigated the allegation; Residents are left alone and determined it to be unsubstantiated. LPA toured the facility and during the visit, LPA interviewed Five of Five (5 of 5) residents, which two of five (2 of 5) residents reported that they have never been left alone and four of four (4 of 4) staff who reported they have never witnessed or heard about any residents being left alone. LPA finds the allegations that Residents are left alone, 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.

Residents are not getting their needs met

LPA investigated the allegation; Residents are not getting their needs met to be unsubstantiated. LPA toured the facility and during the visit, LPA toured the facility and during the visit, LPA interviewed Five of Five (5 of 5) residents, which two of five (2 of 5) residents who all reported that they have never had any issues getting their needs met and four of four (4 of 4) staff who reported they have never witnessed or heard about any issues regarding resident needs not being met. LPA finds the allegations that Residents needs are not being met to be 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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