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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 525002436
Report Date: 09/15/2021
Date Signed: 09/15/2021 11:15:57 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
04/16/2021 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 25-AS-20210416080624
FACILITY NAME:NORTH VALLEY SERVICES - RAWSON HOMEFACILITY NUMBER:
525002436
ADMINISTRATOR:BURNHAM, CATHERINEFACILITY TYPE:
735
ADDRESS:10770 RAWSON RDTELEPHONE:
(530) 527-7987
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY:4CENSUS: DATE:
09/15/2021
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Cindy Zumault - administratorTIME COMPLETED:
11:30 PM
ALLEGATION(S):
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Facility is retaliating against resident due to complaints filed on their behalf.
Facility is restricting visitation for resident.
INVESTIGATION FINDINGS:
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09/15/2021 11:00 AM Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with administrator Cindy Zumault. The purpose of this visit was to deliver the results of the complaint investigation of the above allegations. Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted administrator and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surical mask, gloves.

Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rayna L Bryson
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021
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 25-AS-20210416080624
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: NORTH VALLEY SERVICES - RAWSON HOME
FACILITY NUMBER: 525002436
VISIT DATE: 09/15/2021
NARRATIVE
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It was reported that RP had conversations with the facility office staff regarding the treatment of C1 and RP has filed complaints against the facility on C1’s behalf. RP stated they spoke to a facility staff person and was told that the facility was changing C1's care plan so that if C1 wants to see their friend they have to schedule it 2 weeks ahead of time. RP stated that this is hard for these individuals to manage, as C1 typically calls the friend on the day that C1 is able to hang out. RP stated that staff are retaliating against C1 because RP filed complaints on C1’s behalf.

During the course of the investigation LPA interviewed 2 administrators, 3 care staff, and 1 witness. LPA obtained the following documents to investigate the above allegations: Resident’s Physician’s Report, Individual Program Plan, staff list with contact information.

Allegation: Facility is retaliating against resident due to complaints filed on their behalf. - UNSUBSTANTIATED.

During interviews there was no evidence obtained that would indicate that the facility is retaliating against the resident due to complaints filed on their behalf.

Staff interviews revealed that the facility schedules C1’s visits in advance for C1’s safety and because the facility has had issues with C1 eloping. Staff states that no one would ever stop C1 from going out and seeing their friends. The facility needs to schedule the visits at least 1 week in advance so they can make sure they have enough staff scheduled as C1 requires a staff person to accompany them when they leave the facility.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are unsubstantiated.

Continued on LIC9099-C

SUPERVISORS NAME: Rayna L Bryson
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 25-AS-20210416080624
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: NORTH VALLEY SERVICES - RAWSON HOME
FACILITY NUMBER: 525002436
VISIT DATE: 09/15/2021
NARRATIVE
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Allegation: Facility is restricting visitation for resident. - UNSUBSTANTIATED.

Review of the client’s Individual Program Plan (IPP) revealed that the client needs someone nearby during waking hours to help ensure their safety, and the client requires constant supervision to prevent injury/harm. In order to accommodate the client’s wishes to meet with their friends outside of the facility, the facility has started to schedule these visits in advance in order to ensure the facility has enough staff available to allow the client to meet with friends in the presence of facility staff.

Staff interviews revealed that the facility schedules C1’s visits in advance for C1’s safety and because the facility has had issues with C1 eloping. Staff states that no one would ever stop C1 from going out and seeing their friends. The facility needs to schedule the visits at least 1 week in advance so they can make sure they have enough staff scheduled as C1 requires a staff person to accompany them when they leave the facility.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are unsubstantiated

SUPERVISORS NAME: Rayna L Bryson
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3