455002708-6-10-2021-25-AS-KMKY-C3YVSD-20210614164123

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 455002708
Report Date: 06/09/2021
Date Signed: 06/10/2021 04:45:31 PM

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
05/18/2021 and conducted by Evaluator Misty Valencia

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20210518160654

FACILITY NAME:	LADY OF GRACE CARE FACILITY		FACILITY NUMBER:	455002708
ADMINISTRATOR:	MAYER, CELIA C		FACILITY TYPE:	740
ADDRESS:	277 EDINBURGH PL		TELEPHONE:	(530) 226-1689
CITY:	REDDING	STATE: CA	ZIP CODE:	96003
CAPACITY:	6	CENSUS: 6	DATE:	06/09/2021
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Mayer, Celia Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Resident not given proper eviction notice

INVESTIGATION FINDINGS:

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On 06/10/2021, Licensing Program Analyst (LPA) Misty Valencia conducted an unannounced complaint investigation visit regarding the above allegation and met with Administrator (Admin) Celia Mayer. 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 and gloves. Additionally, LPA was screened by Administrator Celia Mayer. The purpose of the visit is to deliver the following complaint findings: Resident not given proper eviction notice.

continued on 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kevin Mknelly	TELEPHONE: (209) -81-1925
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2021

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 5

Control Number 25-AS-20210518160654

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: LADY OF GRACE CARE FACILITY	FACILITY NUMBER: 455002708
	VISIT DATE: 06/09/2021

NARRATIVE

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Resident not given proper eviction notice

LPA interviewed facility staff, resident, and reviewed records. During the investigation, it was determined that there was sufficient evidence to substantiate Resident not given proper eviction notice. During the investigation, the Admin admitted this is true that she took the call button away. Admin admitted that sometime in December of 2020, when having a discussion with resident 1 (R1)s family about how difficult it was to meet R1’s demands. POA1 asked me to not let her go and let her stay here as they are both happy with the care we provide. Then POA1 hired a private sitter 5 days a week, 3 hours a day, for the sole purpose of taking R1 to the restroom, as often as she desired. It helped for a while but during those times when the sitter was not around is when things got very challenging and difficult for us. I told POA1 that we really could not meet his R1’s needs anymore. I confirm that a verbal 60-day notice was given to POA1 via phone, POA1 confirmed as wel that it was all verbal and a written notice was never provided to R1 or POA1.

Based on the findings of this investigation LPA finds allegations to be SUBSTANTIATED - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies were observed and cited on the following LIC 9099-D pursuant to Title 22 rules and regulations, Health and Safety Codes, and Welfare and Institutions Code.

SUPERVISOR'S NAME: Kevin Mknelly	TELEPHONE: (209) -81-1925
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 25-AS-20210518160654

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: LADY OF GRACE CARE FACILITY	FACILITY NUMBER: 455002708
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/09/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/18/2021 Section Cited CCR 87224(a)(4)	1 2 3 4 5 6 7	Eviction Procedures. (a) The licensee may evict a resident for one or more of the reasons listed ... (1) through (5). (4) If, ... it is determined that the resident has a need... a reappraisal has been conducted...	1 2 3 4 5 6 7	Licensee will submit a statement of understanding of this regulation to CCL by the POC date of 06/18/21.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by R1 was not given an approriate 60 day notice. This posed a potential risk to resident's personal rights.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Kevin Mknelly	TELEPHONE: (209) -81-1925
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 5

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
05/18/2021 and conducted by Evaluator Misty Valencia

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20210518160654

FACILITY NAME:	LADY OF GRACE CARE FACILITY		FACILITY NUMBER:	455002708
ADMINISTRATOR:	MAYER, CELIA C		FACILITY TYPE:	740
ADDRESS:	277 EDINBURGH PL		TELEPHONE:	(530) 226-1689
CITY:	REDDING	STATE: CA	ZIP CODE:	96003
CAPACITY:	6	CENSUS: 6	DATE:	06/09/2021
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Mayer, Celia Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

1
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3
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5
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7
8
9

Resident was not provided care timely.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 6/09/2021, Licensing Program Analyst (LPA) Misty Valencia conducted an unannounced complaint investigation visit regarding the above allegation and met with Administrator Celia Mayer. 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 and gloves. Additionally, LPA was screened by Administrator Celia Mayer. The purpose of the visit is to deliver the following complaint findings;Resident was not provided care timely.

continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kevin Mknelly	TELEPHONE: (209) -81-1925
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 25-AS-20210518160654

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: LADY OF GRACE CARE FACILITY	FACILITY NUMBER: 455002708
	VISIT DATE: 06/09/2021

NARRATIVE

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Resident was not provided care timely.

LPA interviewed facility staff, resident, and reviewed records. During the investigation, it was determined that there was insufficient evidence to substantiate Resident was not provided care timely. Interviews that were conducted concluded that staff and the resident all report R1 only complained about not going to the bathroom right when she wanted to go. R1 denied restriction from using the restroom or getting her other needs met. R1 reported that there were times R1 had to wait a little while because staff was attending to another resident, but R1 was able to go.

Based upon the information obtained during investigation. The above allegations are 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

An exit interview was conducted and a copy of this report, dated 06/10/202 was provided.

SUPERVISOR'S NAME: Kevin Mknelly	TELEPHONE: (209) -81-1925
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2021

LIC9099 (FAS) - (06/04)

Page: 5 of 5