515002613-3-5-2021-25-AS-KHOS-BYXMG6-20210309083522

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 515002613
Report Date: 03/05/2021
Date Signed: 03/05/2021 02:03:08 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
12/21/2020 and conducted by Evaluator Misty Valencia

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20201221130942

FACILITY NAME:	SUMMERFIELD SENIOR LIVING		FACILITY NUMBER:	515002613
ADMINISTRATOR:	GILDEA, CHANTEL		FACILITY TYPE:	740
ADDRESS:	1224 PLUMAS STREET		TELEPHONE:	(530) 755-3850
CITY:	YUBA CITY	STATE: CA	ZIP CODE:	95991
CAPACITY:	99	CENSUS: 68	DATE:	03/05/2021
		UNANNOUNCED	TIME BEGAN:	10:42 AM
MET WITH:	Gildea, Chantel, Administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Neglect-Lack of Care and Supervision

INVESTIGATION FINDINGS:

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Misty Valencia, Licensing Program Analyst (LPA) conducted an unannounced complaint via-telephone with Chantel Gildea, Administrator regarding allegations above.

Neglect-Lack of Care and Supervision-UNSUBSTANTIATED.

LPA interviewed 7/7 staff, and 5/5 residents who all report that they have never witnessed any residents not have their needs met. 5/5 residents all report that they have all have their needs met and have never had any issues getting them met. After conducting interviews. LPA has determined the allegation to be unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred, and the findings are UNSUBSTANTIATED.

continued on 9099-A

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2021

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
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
12/21/2020 and conducted by Evaluator Misty Valencia

COMPLAINT CONTROL NUMBER: 25-AS-20201221130942

FACILITY NAME:	SUMMERFIELD SENIOR LIVING		FACILITY NUMBER:	515002613
ADMINISTRATOR:	GILDEA, CHANTEL		FACILITY TYPE:	740
ADDRESS:	1224 PLUMAS STREET		TELEPHONE:	(530) 755-3850
CITY:	YUBA CITY	STATE: CA	ZIP CODE:	95991
CAPACITY:	99	CENSUS: 68	DATE:	03/05/2021
		UNANNOUNCED	TIME BEGAN:	10:42 AM
MET WITH:	Gildea, Chantel, Administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Personal rights

INVESTIGATION FINDINGS:

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Misty Valencia, Licensing Program Analyst (LPA) conducted an unannounced complaint via-telephone with Chantel Gildea, Administrator regarding allegations above.

continued on LIC9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2021

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-20201221130942

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: SUMMERFIELD SENIOR LIVING	FACILITY NUMBER: 515002613
	VISIT DATE: 03/05/2021

NARRATIVE

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Personal rights – SUBSTANTIATED

On 12/23/2021 LPA Misty Valencia spoke to Administrator Chantel Gildea regarding a Christmas Party that was held on 12/18/2021. There were videos posted on social media showing that there was a Christmas party and staff members who attended were not social distancing or wearing masks. LPA interviewed 7/7 staff member who all reported that they also observed staff not wearing masks, or social distancing during the Christmas party. LPA explained that all facility staff must wear a mask, social distance while in the facility, and at that time no visitors were allowed in the building, due to the current coivd pandemic. The Administrator stated that she did in fact let the staff members know that they must wear masks and social distance during the gathering, but they did not do either.

Based on the interviews and evidence obtained, the preponderance of evidence standard has been met, therefore, the above allegation found to be SUBSTANTIATED.

California Code of Regulations, (Title 22), is being cited on the attached LIC9099D.

Appeal rights were provided, a copy of report was given. An exit interview was conducted with Chantel Gildea, Administrator, via telephone and a copy of this report, dated March 5, 2021 was provided, via email and an electronic email read receipt confirms receiving this document.

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 25-AS-20201221130942

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: SUMMERFIELD SENIOR LIVING	FACILITY NUMBER: 515002613
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/05/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/19/2021 Section Cited CCR 80072(a)(2)	1 2 3 4 5 6 7	Personal Rights...each client shall have personal rights which include, but are not limited to, the following: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs	1 2 3 4 5 6 7	The administrator agrees to provide training to staff on the requirement to staff to wear masks while in the facility.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by:Based on LPAs observations and interviews multiple staff members were observed not wearing masks, which poses a potential health and safety risk to clients in care.	8 9 10 11 12 13 14	Proof of completion shall be sent to the licensing agency by 3/19/2021
	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: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2021

LIC9099 (FAS) - (06/04)

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