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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 525002435
Report Date: 09/02/2025
Date Signed: 09/02/2025 12:20:01 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
07/23/2025 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 59-AS-20250723102054
FACILITY NAME:NORTH VALLEY SERVICES - LUCKNOW HOMEFACILITY NUMBER:
525002435
ADMINISTRATOR:FOSTER, TONYAFACILITY TYPE:
735
ADDRESS:502 LUCKNOW AVETELEPHONE:
(530) 737-8071
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY:3CENSUS: DATE:
09/02/2025
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Tonya Foster - administratorTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff do not ensure that residents' rooms are cleaned. - UNSUBSTANTIATED
Facility is malodorous. - UNSUBSTANTIATED
INVESTIGATION FINDINGS:
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09/02/2025 11:45 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility unannounced to deliver the results of a complaint investigation. LPA met with administrator Tonya Foster and explained the purpose of the visit.

During the course of the investigation LPA conducted interviews and toured the facility.

Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2025
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 2
Control Number 59-AS-20250723102054
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: NORTH VALLEY SERVICES - LUCKNOW HOME
FACILITY NUMBER: 525002435
VISIT DATE: 09/02/2025
NARRATIVE
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Staff do not ensure that residents' rooms are cleaned.- UNSUBSTANTIATED

It was reported that the floor in the bedroom(s) are dirty and trash bags are piled in the bedroom(s).

During the facility’s annual inspection on 07/10/2025 LPA observed one client room to be extremely cluttered and dirty with food items in the room. LPA issued a physical plant citation during the annual inspection related to the uncleanliness of Client 1’s (C1’s) room.

On 08/18/2025 LPA received an email from the administrator which states on 08/23/2025 the administrator, facility staff and the behaviorist are going to complete the room cleaning for C1. LPA reviewed a housekeeping schedule specific to C1 that outlines various tasks that staff will complete on each day of each week specific to maintaining the cleanliness of C1’s room.

Service coordinator stated they visited the facility three or four times in the last month and found C1’s room to be progressively getting better.

It was determined that on 07/10/2025 LPA issued a citation to the facility regarding the uncleanliness of one client’s room. The facility has submitted a plan to address the uncleanliness of C1’s room that includes both immediate and long-term cleaning duties of staff working with C1 to maintain the cleanliness of the room. On 09/02/2025 LPA was informed that C1 had moved out of the facility on 08/30/2025.

Facility is malodorous. – UNSUBSTANTIATED

It was reported that there is an odor in the facility.

LPA toured the facility on 07/29/2025 and on 07/10/2025. The facility was not malodorous on either of these dates.

Service coordinator stated one time they observed a foul odor but that happened just the one time.

Administrator stated there are no incontinent clients living in the facility.

This allegation is 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. No deficiencies cited. Exit interview conducted and a copy of the report was provided to administrator Tonya Foster.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2