455002787-3-20-2023-25-AS-KHOS-CQDHSZ-20230329062758

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 455002787
Report Date: 03/20/2023
Date Signed: 03/20/2023 10:01:46 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/28/2022 and conducted by Evaluator Donna Gurriere

COMPLAINT CONTROL NUMBER: 25-AS-20220928102812

FACILITY NAME:	SIERRA OAKS OF REDDING		FACILITY NUMBER:	455002787
ADMINISTRATOR:	BOBAN, KRISTINE		FACILITY TYPE:	740
ADDRESS:	1520 COLLYER DR.		TELEPHONE:	(541) 840-4035
CITY:	REDDING	STATE: CA	ZIP CODE:	96003
CAPACITY:	113	CENSUS: 78	DATE:	03/20/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	MINDY RACHAEL		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff are not properly trained.

INVESTIGATION FINDINGS:

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

Donna Gurriere and Sarah Benson , Licensing Program Analysts (LPAs) were in contact and met with Mindy Rachael, Assistant Director.

LPA Gurriere and LPA Benson completed the required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID 19 infection to affirm no COVID-19 related symptoms. The administrator/staff person was contacted to complete a facility risk assessment. LPA Gurriere ensured that hand sanitizer was applied before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask. Additionally, LPAs were screened by a staff person upon entering the facility.

continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2023

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 4

Control Number 25-AS-20220928102812

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: SIERRA OAKS OF REDDING	FACILITY NUMBER: 455002787
	VISIT DATE: 03/20/2023

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

During the interviewing process, the administrator, dietary director and eight staff persons were interviewed. In addition, documents were received to include training documents. The administrator provided a list of the required training for initial staff training of 40 hours, annual care giving staff of 20 hours and medication technician training of 24 hours.

During the investigation process, it was reported that nearly all staff persons felt that they had received adequate training. Staff reported that some of the training topics included Assistance with Daily Living (ADLs) which included bathing, transferring, ambulating, grooming, dressing, eating, toileting and personal hygiene. Additional training topics included dietary needs, diabetes care, medications, personal rights, fire safety, hospice care and universal precautions.

Although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are Unsubstantiated.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/28/2022 and conducted by Evaluator Donna Gurriere

COMPLAINT CONTROL NUMBER: 25-AS-20220928102812

FACILITY NAME:	SIERRA OAKS OF REDDING		FACILITY NUMBER:	455002787
ADMINISTRATOR:	BOBAN, KRISTINE		FACILITY TYPE:	740
ADDRESS:	1520 COLLYER DR.		TELEPHONE:	(541) 840-4035
CITY:	REDDING	STATE: CA	ZIP CODE:	96003
CAPACITY:	113	CENSUS: 78	DATE:	03/20/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	MINDY RACHAEL		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility kitchen refrigerator door is in disrepair.

INVESTIGATION FINDINGS:

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

Donna Gurriere and Sarah Benson, Licensing Program Analysts (LPAs) were in contact and met with Mindy Rachael

LPA Gurriere and LPA Benson completed the required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID 19 infection to affirm no COVID-19 related symptoms. The administrator/staff person was contacted to complete a facility risk assessment. LPA Gurriere ensured that hand sanitizer was applied before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask. Additionally, LPA Gurriere was screened by a staff person upon entering the facility.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2023

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

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 25-AS-20220928102812

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: SIERRA OAKS OF REDDING	FACILITY NUMBER: 455002787
	VISIT DATE: 03/20/2023

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

During the interviewing process, the administrator, dietary director and eight staff persons were interviewed. In addition, a walk-through of the facility was conducted by Rebecca Knight, LPA, whereas she inspected the refrigerator door.

Rebecca Knight, LPA reported that she observed the door of the walk-in refrigerator to be securely closed. The administrator and the dietary director confirmed that the secondary latch (hinge that pulls the door closed as a fail-safe) has been malfunctioning, but assured LPA Knight that the part was on order to complete the repair. The malfunctioning of the fail-safe latch did not prevent LPA Knight from easily closing and securing the door.

Due to the aforementioned investigation, the department finds the allegation to be Unfounded. A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4