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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455002787
Report Date: 08/02/2022
Date Signed: 08/02/2022 01:10:56 PM

Substantiated


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
07/29/2022 and conducted by Evaluator Misty Valencia
COMPLAINT CONTROL NUMBER: 25-AS-20220729161317
FACILITY NAME:SIERRA OAKS OF REDDINGFACILITY NUMBER:
455002787
ADMINISTRATOR:BOBAN, KRISTINEFACILITY TYPE:
740
ADDRESS:1520 COLLYER DR.TELEPHONE:
(541) 840-4035
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:113CENSUS: DATE:
08/02/2022
UNANNOUNCEDTIME BEGAN:
10:47 AM
MET WITH:Kristine Boban, Administrator TIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Financial Abuse
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
ON 08/02/2022 Licensing Program Analysts (LPAs) Misty Valencia and Shannon Dieagoruelas arrived at the facility to conduct an announced complaint investigation and met Kristine Boban, Administrator Prior to visits 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 licensee and completed a facility risk assessment. LPAs ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Mask, gown, gloves. Additionally, LPAs were screened by facility staff.

continued on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty ValenciaTELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022
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 25-AS-20220729161317
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: SIERRA OAKS OF REDDING
FACILITY NUMBER: 455002787
VISIT DATE: 08/02/2022
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
SUBSTANTIATED

It was alleged that the Licensee did not issue a refund within the thirty (30) day guidelines upon the death of a resident and the removal of the resident's personal property. The Administrator stated that the refund had not been issued for Resident 1 (R1) of 08/02/2022. LPA explained that per Admissions Agreement of 5495.00 monthly rate, R1’s responsible party should be refunded prorated 5314.36 as signed in admissions agreement. R1 passed away on June 1, 2022, and the belongings were removed by the family on that same day. It was determined that the Licensee did not refund the balance of the monthly fees after the resident's death and removal of the resident's property within the required 30 days. The Admission agreement that the Administrator provided noted that the refund would be issued within 30 days of a residents death and belongings removal.


Based on the evidence obtained, the preponderance of evidence standard has been met, therefore the allegation is found to be substantiated. The following deficiency was cited per CA Code of Regulations Title 22- refer to the 9099-D.

Exit interview completed and copy of report emailed to Admin.

SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty ValenciaTELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 25-AS-20220729161317
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: SIERRA OAKS OF REDDING
FACILITY NUMBER: 455002787
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/02/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/09/2022
Section Cited
CCR
1569.652(c)
1
2
3
4
5
6
7
Termination of admission agreement upon death of resident; removal of resident’s property; refund of fees paid; notice of contract termination and refunds. (c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility...
1
2
3
4
5
6
7
The Administrator agrees to meet with reposible managment regarding the refund in the amount of $5314.36 to resident #1's responsible party.


8
9
10
11
12
13
14
This requirement is not met as evidenced by: based on Adminitrator did not refund one of one (1/1) responsible's party, which poses a potential health and safety risk to client in care.
8
9
10
11
12
13
14
Proof of refund with be sent to CCL by 08/09/2022.
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: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty ValenciaTELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3