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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455002694
Report Date: 08/20/2024
Date Signed: 08/20/2024 10:50:29 AM

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
05/17/2024 and conducted by Evaluator Ivan Avila
COMPLAINT CONTROL NUMBER: 59-AS-20240517140030
FACILITY NAME:PRS - BRIDGER HOUSEFACILITY NUMBER:
455002694
ADMINISTRATOR:MCGUIRE, DWIGHTFACILITY TYPE:
735
ADDRESS:3521 BRIDGER DRTELEPHONE:
(530) 921-4077
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY:6CENSUS: 3DATE:
08/20/2024
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Dwight McGuireTIME COMPLETED:
11:10 AM
ALLEGATION(S):
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Staff neglected resident
INVESTIGATION FINDINGS:
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On 08/20/2024 Licensing Program Analyst (LPA) Ivan Avila conducted an unannounced complaint investigation visit regarding the above allegation directed by the Department. LPA met with Dwight McGuire and explained the purpose of the visit.

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

LPA investigated the allegation, “Staff neglected resident.” Based on interviews conducted C1s bedding was covered with their bowel movement and clothes were soiled when afternoon staff arrived at the facility for a change of shift. C1 had multiple bowel movement accidents a day and was not changed in a timely manner. Pictures were submitted to LPA that showed the soiled bedding C1 was sleeping on. LPA also observed pictures of C1s toenails that had not been trimmed causing C1 to have foot problems and could not wear shoes due to the pain and discomfort.
---Continued on LIC9099-C---
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
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 3
Control Number 59-AS-20240517140030
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: PRS - BRIDGER HOUSE
FACILITY NUMBER: 455002694
VISIT DATE: 08/20/2024
NARRATIVE
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Based on LPAs observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, and the California Health and Safety Code are cited on the attached LIC9099-D.

An exit interview was conducted, and a copy of the report and appeal rights were provided.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 59-AS-20240517140030
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: PRS - BRIDGER HOUSE
FACILITY NUMBER: 455002694
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/30/2024
Section Cited
CCR
80065(a)
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80065(a) Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs. This requirement is not met as evidence by:
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Facility will complete a statement of understanding regarding regulation 80065(a). Facility will submit statement of understanding to LPA by POC due date of 08/30/2024
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Based on interviews and record review, the licensee did not comply with the section cited above as client had been left in soiled bedding and client's toe nails were neglected, which possesses a potential Health, Safety, and Personal Rights risk to persons in care.
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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: Anthony Perez
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3