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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455002618
Report Date: 12/08/2021
Date Signed: 12/09/2021 11:50:04 AM

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
10/14/2021 and conducted by Evaluator Misty Valencia
COMPLAINT CONTROL NUMBER: 25-AS-20211014163655
FACILITY NAME:DE MOLL HOMEFACILITY NUMBER:
455002618
ADMINISTRATOR:VICTORINE, CHAYLENEFACILITY TYPE:
735
ADDRESS:1213 DE MOLL DRIVETELEPHONE:
(530) 410-9627
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY:4CENSUS: 4DATE:
12/08/2021
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Iliana Cortez, Facility ManagerTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Client is not being fed properly.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/08/2021, Licensing Program Analyst (LPA) Misty Valencia conducted an unannounced complaint investigation visit regarding the above allegation. LPA met with Iliana Cortez, Facility Manager and explained the reason for the visit. Prior to initiating the 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: N-95mask. Additionally, LPA was screened by staff at the front door.

continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Misty Valencia
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2021
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-20211014163655
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: DE MOLL HOME
FACILITY NUMBER: 455002618
VISIT DATE: 12/08/2021
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
Client is not being fed properly


LPA investigated the allegation; Client is not being fed properly to be unsubstantiated. LPA toured the facility and during the visit, LPA reviewed the food supply in the kitchen, refrigerator and freezer, it was apparent that the facility had a minimum of one week perishable foods and a minimum of two (2) days non-perishable foods. LPA interviewed Four of Four (4 of 4) clients, which two of four (2 of 4) residents reported that they do get food, just not want they want to eat every day. They reported that they will order something if they dislike what is on the menu for the day. LPA interviewed three of three (3 of 3) staff, who reported they do not do weekly menus, but daily menus because they never know what the clients want to eat. Three of three (3 of 3) staff, and Admin, who all reported that they do weekly grocery shopping trips or get food delivered. Staff reported that they have never witnessed or heard any issues regarding the clients are not getting fed properly. LPA finds the allegation that client is not being fed properly 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 will be emailed to Ms. Victorine, Administrator. An exit interview was conducted
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Misty Valencia
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2