525002212-9-17-2024-59-AS-KHOS-D9EKGX-20240924075415

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 525002212
Report Date: 09/17/2024
Date Signed: 09/17/2024 10:15:21 AM

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
07/03/2024 and conducted by Evaluator Donna Gurriere

COMPLAINT CONTROL NUMBER: 59-AS-20240703090518

FACILITY NAME:	MASON'S RESIDENCE III		FACILITY NUMBER:	525002212
ADMINISTRATOR:	MASON, ERIC		FACILITY TYPE:	735
ADDRESS:	60 SHERMAN DRIVE		TELEPHONE:	(530) 527-3122
CITY:	RED BLUFF	STATE: CA	ZIP CODE:	96080
CAPACITY:	5	CENSUS: 1	DATE:	09/17/2024
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	BABE MASON		TIME COMPLETED:	10:20 AM

ALLEGATION(S):

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Staff do not ensure clients are accorded dignity and respect in their personal relationships.
Staff do not ensure sufficient activities and outings are planned for clients in care.
Staff do not ensure the facility is kept in clean sanitary conditions for clients in care.

INVESTIGATION FINDINGS:

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On 09/17/24 Donna Gurriere, Licensing Program Analyst (LPA) arrived at the facility unannounced to deliver final findings regarding a complaint that was received on 07/03/24. LPA Gurriere met with Babe Mason, Administrator and explained the purpose of the visit.

Staff do not ensure clients are accorded dignity and respect in their personal relationships.

During the interview process, the administrator, regional center service coordinator, three staff persons and two residents (Resident 1 and Resident 2) were interviewed. Resident 3 was not interviewed as he has since moved to Redding, California. Documents were obtained to include the resident’s (Resident 3) Individual Program Plan (IPP) and Physician’s Report. Staff names and telephone numbers were also obtained.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Donna Gurriere
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024

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-20240703090518

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: MASON'S RESIDENCE III	FACILITY NUMBER: 525002212
	VISIT DATE: 09/17/2024

NARRATIVE

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During the investigation process, it was reported by the administrator, regional center service coordinator, staff persons and residents that the residents at the facility are treated with dignity and respect in their personal relationships with staff.

Staff do not ensure sufficient activities and outings are planned for clients in care.

During the interview process, the administrator, regional center service coordinator, three staff persons and two residents (Resident 1 and Resident 2) were interviewed. Resident 3 was not interviewed as he has since moved to Redding, California.

During the investigation process, it was reported that the residents do attend various outings to include parades, the apple festival, shopping, weekly baseball, rodeo, dances, lunches weekly and trips to WalMart. It was stated that all the residents are active and are generally seen out in the community with each other and friends. It was reported overall that Resident 3 did not want to participate in the resident activities; he was very independent and would socialize with his own friends.

Staff do not ensure the facility is kept in clean sanitary conditions for clients in care.

During the interview process, the administrator, regional center service coordinator, three staff persons and two residents (Resident 1 and Resident 2) were interviewed. Resident 3 was not interviewed as he has since moved to Redding, California.

During the investigation process, it was reported that the facility is kept clean and sanitary. Staff reported that they are cleaning daily to include mopping, vacuuming, cleaning rooms, the kitchen and bathrooms. LPA Knight was at the facility recently and reported that the facility is generally maintained clean and tidy.

Although the above allegations mentioned may have happened, or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and all of the above findings are Unsubstantiated.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Donna Gurriere
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024

LIC9099 (FAS) - (06/04)

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