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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 525002212
Report Date: 11/18/2024
Date Signed: 11/18/2024 11:09:14 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
11/12/2024 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 59-AS-20241112113457
FACILITY NAME:MASON'S RESIDENCE IIIFACILITY NUMBER:
525002212
ADMINISTRATOR:MASON, ERICFACILITY TYPE:
735
ADDRESS:60 SHERMAN DRIVETELEPHONE:
(530) 527-3122
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY:5CENSUS: 3DATE:
11/18/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Margaret Waldron - care staffTIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident is being locked in her room -UNSUBSTANTIATED
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
11/18/2024 10:00 AM Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with care staff Margaret Waldron. Licensee Babe Mason is home recovering from an unexpected medical procedure and was unable to attend the meeting. The purpose of this visit was to conduct a complaint investigation.

LPA toured the facility and inspected the keyed lock on Client 1's (C1) door. LPA observed that the lock can be locked and opened by a key from the outside or locked by a button from the inside and opened from the inside by turning the handle. It would not be possible for C1 to have been locked inside of their room. This allegation is unsubstantiated.

No deficiencies cited. Exit interview conducted and a copy of the report was provided to care staff Margaret Waldron.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024
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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