515001963-6-28-2024-59-AS-TORZ-D6S2G4-20240701172229

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 515001963
Report Date: 06/28/2024
Date Signed: 06/28/2024 12:57:33 PM

Unfounded

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
06/28/2024 and conducted by Evaluator Kerry Hiratsuka

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20240628080725

FACILITY NAME:	WILLOW GLEN CARE CENTER		FACILITY NUMBER:	515001963
ADMINISTRATOR:	ANGIE KARIS		FACILITY TYPE:	740
ADDRESS:	1547 PLUMAS COURT		TELEPHONE:	(530) 751-9900
CITY:	YUBA CITY	STATE: CA	ZIP CODE:	95991
CAPACITY:	60	CENSUS: 59	DATE:	06/28/2024
		UNANNOUNCED	TIME BEGAN:	11:25 AM
MET WITH:	Angis Karis		TIME COMPLETED:	01:10 PM

ALLEGATION(S):

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Facility air conditioner in disrepair and not being addressed

INVESTIGATION FINDINGS:

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LPA Hiratsuka, conducted this unannounced complaint visit.

LPA toured the facility, interviewed two staff, and interviewed Administrator Angie Karis. This facility has two wings for residents and the wings meet in the middle where there is a central enclosed area for staff. The central enclosed area for staff has an office, staff lounge, medication/charting area, and linen closet. This is the area that has a broken motor for the air conditioner. The air conditioner broke on Monday, June 24, 2024, a repair company was called the same day and came on Tuesday, June 25, 2024 and a part was ordered for the unit. An update for the part that was ordered should tentatively be coming in five to ten days and that should include installation. If there is a delay the facility does have fans and has other accommodations. The resident areas are not affected. LPA was also informed the air conditioner and heater units are checked quarterly by the facility maintenance team.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Kerry Hiratsuka	TELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2024

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

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20240628080725

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: WILLOW GLEN CARE CENTER	FACILITY NUMBER: 515001963
	VISIT DATE: 06/28/2024

NARRATIVE

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LPA toured the facility and observed fans blowing in the areas affected. There fans are placed to not be tripping hazards that are blowing cooler air into the affected areas. The facility always has hydration stations for everyone. Staff have been allowed to take breaks in other areas of the facility to avoid being in the staff lounge. Medications that have to be kept cold are stored in a locked refrigerator and any medications that require specific temperatures have been checked and stored in appropriate areas. The resident wings and rooms are not affected.

Because there was no warning for the air conditioner dying, the repair service being called the day the air conditioner died, the facility placing fans in cooler areas to blow air into the warm areas to try to cool the affected areas, always having hydration stations, and medication storage adjustments if required have been done, the allegation is UNFOUNDED.

A finding that an allegation is UNFOUNDED means that the allegation is false, could not have happened, and/or is without a reasonable basis.

No deficiencies are cited at this visit. Exit interview conducted.

SUPERVISOR'S NAME: Troy Ordonez	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Kerry Hiratsuka	TELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2024

LIC9099 (FAS) - (06/04)

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