515002008-4-30-2021-25-AS-KHOS-C2QMYB-20210505100117

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 515002008
Report Date: 03/27/2021
Date Signed: 04/30/2021 02:51:56 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
11/04/2020 and conducted by Evaluator Pheej Cheng

COMPLAINT CONTROL NUMBER: 25-AS-20201104094124

FACILITY NAME:	EMERALD OAKS		FACILITY NUMBER:	515002008
ADMINISTRATOR:	SANDHU, SUKHJIT		FACILITY TYPE:	740
ADDRESS:	2290 FORREST LANE		TELEPHONE:	(530) 751-0511
CITY:	YUBA CITY	STATE: CA	ZIP CODE:	95993
CAPACITY:	0	CENSUS: 0	DATE:	03/27/2021
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Rita Hammill; Licensee		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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1) Resident is denied phone calls.
2) Resident is denied visitors.
3) Resident is not able to receive delivered correspondences.
4) Resident is not receiving requested medical services.

INVESTIGATION FINDINGS:

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**This report is being amended from the original dated of 3/27/21 to change the findings in the original report. **

On 3/27/21 at 2PM, Licensing Program Analyst (LPA) Cheng conducted an unannounced complaint visit via telephone and spoke to Licensee Rita Hammill. A telephone call was conducted in compliance to the department's procedures regarding COVID-19. Complaint was initially opened under facility license #515002008; however, the license is no longer active as there has been a change of ownership. Hammill provided LPA with an e-mail so that she can provide a copy of the report.

Continuation on LIC 9099C.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Kevin Mknelly	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Pheej Cheng	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2021

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 25-AS-20201104094124

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: EMERALD OAKS	FACILITY NUMBER: 515002008
	VISIT DATE: 03/27/2021

NARRATIVE

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1) Resident is denied phone calls.

Based on statements obtained, LPA determined that there are insufficient statements available. All statements from staff and residents indicate residents have access to facility phones. All residents were able to identify and confirm that facility phones are located in resident hallways. All staff and residents interviewed stated there were no incidents where residents were denied access to phones.

2) Residents is denied visitors.

Based on statements obtained, LPA determined that there are insufficient statements available. Staff and residents were able to confirmed that although visitation was limited due to local county health and CCLD guidelines, the facility provided other forms of visitation. Residents confirmed that window and video visitations were utilized. Residents confirmed that they were never denied any visitation.

3) Resident is not able to receive delivered correspondences.

Based on statements obtained, LPA determined that there are insufficient statements available. All statements from staff and residents indicate that mail is delivered by S2 in person. For individuals who have a conservator or power of attorney, specific requests and procedures have been put in place to ensure that all important and time sensitive mail can be addressed correctly. All residents interviewed confirmed that they are receiving their mail.

Continuation on LIC 9099C.

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Pheej Cheng	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2021

LIC9099 (FAS) - (06/04)

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Control Number 25-AS-20201104094124

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: EMERALD OAKS	FACILITY NUMBER: 515002008
	VISIT DATE: 03/27/2021

NARRATIVE

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**This report is being amended from the original dated of 3/27/21 to change the findings in the original report. **

4) Resident is not receiving requested medical services.

Based on statements obtained, LPA determined that there are insufficient statements available. All statements from staff and residents indicate medical services and appointments are continuing as normal. Residents stated that although a majority of in-person medical appointments have been moved to telephone appointments, these medical services are still being conducted. Residents, conservators, responsible parties, and POA’s are working with primary care physicians to establish a safe and effective system for providing care. Transportation services are normally provided by family members, conservators, or POAs’; however, third party medical transportation services are available at resident’s request. All residents and staff confirm that medical services are still being received as normal.

This agency has investigated the complaint allegations listed above. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.

Exit interview conducted and a copy of report was provided.

SUPERVISOR'S NAME: Kevin Mknelly	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Pheej Cheng	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2021

LIC9099 (FAS) - (06/04)

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