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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 515002617
Report Date: 12/08/2022
Date Signed: 12/08/2022 01:56:06 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 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
12/05/2022 and conducted by Evaluator Kerry Hiratsuka
COMPLAINT CONTROL NUMBER: 25-AS-20221205161730
FACILITY NAME:CHERRY BLOSSOM ASSISTED LIVINGFACILITY NUMBER:
515002617
ADMINISTRATOR:CRAIG VINCELETFACILITY TYPE:
740
ADDRESS:1880 LIVE OAK BLVDTELEPHONE:
(530) 212-8010
CITY:YUBA CITYSTATE: CAZIP CODE:
95991
CAPACITY:79CENSUS: 26DATE:
12/08/2022
UNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Melanie Byrd, Site SupervisorTIME COMPLETED:
02:05 PM
ALLEGATION(S):
1
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9
Facility not providing adequate food service.
INVESTIGATION FINDINGS:
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2
3
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5
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10
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12
13
LPA Hiratsuka, conducted the investigation into the allegations above. LPA wore a surgical mask during visit and observed all staff wearing surgical masks.

LPA Hiratsuka investigated the allegations: Facility not providing adequate food service.

LPA interviewed 11 residents. LPA also received the menu for the week and observed lunch being served. All residents stated the food is good and they get enough to eat. They had no complaints about food quality.

Based on the above, the allegation is unfounded.

“This agency has investigated the complaint alleging; Facility not providing adequate food service. 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.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
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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