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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455002976
Report Date: 05/17/2023
Date Signed: 05/17/2023 03:22:02 PM

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
03/23/2023 and conducted by Evaluator Kerry Hiratsuka
COMPLAINT CONTROL NUMBER: 59-AS-20230323083532
FACILITY NAME:GOLDEN OAKS SENIOR LIVINGFACILITY NUMBER:
455002976
ADMINISTRATOR:WILLIAMS, KENNETHFACILITY TYPE:
740
ADDRESS:779 KERRYJEN CT.TELEPHONE:
(530) 223-1538
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY:26CENSUS: 14DATE:
05/17/2023
UNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Evelyn Williams and Melissa JohnsonTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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9
1. Cleaning toxin accessible to residents.
2. Medications accessible to residents
INVESTIGATION FINDINGS:
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3
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LPA HIratsuka, conducted this unannounced complaint visit. LPA conducted the investigation into the allegations above.

1. LPA interviewed the staff. All staff state they keep cleaning toxins locked up. Complainant stated during the visit that staff left cleaning toxins unlocked. LPA toured the facility and did not see any cleaning toxins out or unlocked today and on 03/28/2023. LPA cannot prove or disprove allegation because each side has their own version of events.

2. Complainant stated an ointment and a body soap was found on one of the toilets during a visit. LPA toured the facility today and on 03/28/2023, and did not see any. Staff interviewed stated they have not left anything out. LPA cannot prove or disprove allegation because each side has their own version of events.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023
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
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
03/23/2023 and conducted by Evaluator Kerry Hiratsuka
COMPLAINT CONTROL NUMBER: 59-AS-20230323083532

FACILITY NAME:GOLDEN OAKS SENIOR LIVINGFACILITY NUMBER:
455002976
ADMINISTRATOR:WILLIAMS, KENNETHFACILITY TYPE:
740
ADDRESS:779 KERRYJEN CT.TELEPHONE:
(530) 223-1538
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY:26CENSUS: 14DATE:
05/17/2023
UNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Evelyn Williams and Melissa JohnsonTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
1. Facility does not have a variety of food.
2. Residents not given enough food to eat.
3. Facility is in disrepair
4. Staff is not trained properly
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LPA Hiratsuka, conducted this unannounced complaint visit.

LPA investigated the allegations above. LPA reviewed staff records, interviewed residents, toured the facility, and interviewed staff.

1. There is a variaty of food. The snacks are available upon request and some are left out. The facility also caters to what residents like to eat. Allegation unfounded

2. LPA interviewed residents. They either stated they get enough or indicated they get enough to eat. Staff stated they recognize resident's body language when the resident is hungry or thirsty. Allegation unfounded
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 59-AS-20230323083532
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: GOLDEN OAKS SENIOR LIVING
FACILITY NUMBER: 455002976
VISIT DATE: 05/17/2023
NARRATIVE
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3. There are two fuse boxes that had tape over them. Title 22 regulations does not state the fuse boxes need to be locked. The fuse box doors are not broken. When the tape was taken off the doors snapped shut, stayed shut, and had to be pulled open by the latch. LPA was informed during the visit on 03/28/2023, that the tape was placed over the doors to prevent former residents from opening the doors, but they have long moved out and no one has tried to open them since. The tape did not appear to be tampered with during the visits. Allegation unfounded.

4. LPA reviewed the staff training. All staff have the training required by Title 22 regulations. Allegation unfounded.

“This agency has investigated the complaint alleging;1. Facility does not have a variety of food; 2. Residents not given enough food to eat; 3. Facility is in disrepair; and 4. Staff is not trained properly. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis."
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 59-AS-20230323083532
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: GOLDEN OAKS SENIOR LIVING
FACILITY NUMBER: 455002976
VISIT DATE: 05/17/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
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15
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Due to the information gathered, LPA cannot determine the 1. Cleaning toxin accessible to residents; and
2. Medications accessible to residents. LPA finds allegation to be unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are unsubstantiated.
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4