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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 515002742
Report Date: 07/31/2024
Date Signed: 07/31/2024 03:23:05 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, 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
03/11/2024 and conducted by Evaluator Kerry Hiratsuka
COMPLAINT CONTROL NUMBER: 59-AS-20240311161504
FACILITY NAME:YUBA SUTTER CARE HOME INC.FACILITY NUMBER:
515002742
ADMINISTRATOR:KAUR, RAJVEERFACILITY TYPE:
740
ADDRESS:920 BOGUE ROADTELEPHONE:
(530) 777-6476
CITY:YUBA CITYSTATE: CAZIP CODE:
95991
CAPACITY:6CENSUS: 6DATE:
07/31/2024
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Manpreet DyalTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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9
Facility is in disrepair.
Licensee does not ensure a safe environment for residents in care.
Licensee does not ensure a sanitary environment for residents in care
INVESTIGATION FINDINGS:
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13
LPA Hiratsuka conducted this visit to deliver the results of the investigation above. LPA met with Manpreet Dyal.
During the investigation the administrator, licensee, caregivers, and residents were interviewed. LPA also toured facility on three separate visits.

1. LPA interviewed residents and staff. Complainant alleged the heater for the facility wasn’t working. LPA did not have any complaints from the residents. Complainant stated a toilet in one of the resident’s rooms plugged and overflowed with sewage. One resident who does not reside in the room stated it was small leak from the toilet that was fixed quickly and doesn’t recall hearing about any of the toilets plugging and overflowing. Two resident rooms have full bathrooms and LPA was informed they have not plugged or overflowed during the interviews. LPA was told the common bathroom has not had any issues. LPA toured the facility three times. LPA did observed marks on the hallway walls that could be caused by wheelchairs or walkers bumping in the walls, the doorways to the bedrooms have marks on the floor that was left over from the doors being widened but none of that poses any risks to residents.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024
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 3
Control Number 59-AS-20240311161504
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: YUBA SUTTER CARE HOME INC.
FACILITY NUMBER: 515002742
VISIT DATE: 07/31/2024
NARRATIVE
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There is a walkway from the front of the facility to the back that has steps on one side and a ramp on the other. The steps are marked with tape and the tape was peeling, but it does not pose a risk because the steps were still clearly marked. LPA cannot prove or disprove the allegation.

2. Complainant stated the stove top vent above the stove tops and the clothes dryer were not ventilated and emitted toxic fumes or did not ventilate toxic fumes. LPA contacted Sutter County Building Inspector and Sutter County Fire Inspector. The stove top itself is electric and does not emit toxic fumes. The fan over the stove top is a fan that blows air away from the food and is not required to vent to the outside. The clothes dryer at the time of the complaint being made was installed in the garage was electric and not vented to the outside because the person who delivered the unit did not install it properly. LPA contacted the company that built the clothes dryer and the Sutter County Building Inspector, and both stated the clothes dryer does not emit toxic fumes. The only concern was lint build-up and damp air being emitted from the clothes dryer. The licensee has since switched it to a ventless clothes dryer. However, based on the above the two issues do not pose a danger to residents. Complainant stated caregivers would leave the sharp knives in the kitchen unlocked and one of the residents was able to get into the drawer. LPA was given a time frame ending roughly April 2024. LPA was unable to confirm the events. Complainant alleged the hot water heater was dangerous and Licensee stated she has not had any issues with the hot water heater, nor has she had any complaints about the hot water heater. LPA did not receive any complaints about the hot water heater from the residents who were interviewed. LPA did not observe any issues with the hot water heater. LPA cannot prove or disprove the above.

3. Complainant stated the toilets plugged all the time and overflowed and the caregivers didn’t clean any of it up. Interviews all stated that didn’t happen. LPA was unable to interview past caregivers. LPA cannot prove or disprove the allegation.

Due to the information gathered, LPA cannot determine the allegations: 1 Facility is in disrepair; 2. Licensee does not ensure a safe environment for residents in care; 3. Licensee does not ensure a sanitary environment for residents in care. 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: Troy OrdonezTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
03/11/2024 and conducted by Evaluator Kerry Hiratsuka
COMPLAINT CONTROL NUMBER: 59-AS-20240311161504

FACILITY NAME:YUBA SUTTER CARE HOME INC.FACILITY NUMBER:
515002742
ADMINISTRATOR:KAUR, RAJVEERFACILITY TYPE:
740
ADDRESS:920 BOGUE ROADTELEPHONE:
(530) 777-6476
CITY:YUBA CITYSTATE: CAZIP CODE:
95991
CAPACITY:6CENSUS: 6DATE:
07/31/2024
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Manpreet DyalTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff with no criminal record clearance working in facility.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LPA Hiratsuka conducted this visit to deliver the results of the investigation above. LPA met with Manpreet Dyal.
During the investigation the administrator, licensee, caregivers, and residents were interviewed. LPA also toured facility on three separate visits.

Complainant stated a caregiver that worked at the facility with no criminal record clearance still worked at the facility. Complainant stated caregiver LPA cited the licensee for in July 2023 for not working with criminal record clearance still worked at the facility. LPA confirmed with residents that it was not the same caregiver. Licensee stated the caregiver LPA cited her was only there on a trial basis and never came back after LPA’s visit in July 2023. Based on information above, the department concluded that the allegations are 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 cited
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024
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 3