<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 525002590
Report Date: 04/15/2025
Date Signed: 04/24/2025 10:54:36 AM

Substantiated


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
02/04/2025 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 59-AS-20250204165221
FACILITY NAME:GILMORE RANCH HOMEFACILITY NUMBER:
525002590
ADMINISTRATOR:FOSTER, TONYAFACILITY TYPE:
735
ADDRESS:22030 GILMORE RANCH RDTELEPHONE:
(530) 529-0629
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY:4CENSUS: 4DATE:
04/15/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Tonya Foster - administratorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Client left in facility unsupervised. - SUBSTANTIATED
Staff member verbally abuses clients in care. - SUBSTANTIATED
Uncleared adult working at the facility. - SUBSTANTIATED
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
*** Report amended Additional report for amended findings***
04/24/2025 10:30 AM Licensing Program Analysts (LPAs) Rebecca Knight and Kayla Adkison made an unannounced visit to the facility and met with administrator Tonya Foster. The purpose of this visit was to deliver the ammended results of a complaint investigation which includes civil penalties.

During the course of the investigation LPA interviewed the program director, administrator, client and staff. LPA reviewed the following documents: staff list with telephone numbers, Guardian facility roster, DOJ background clearance.

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

DATE: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
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 5
Control Number 59-AS-20250204165221
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: GILMORE RANCH HOME
FACILITY NUMBER: 525002590
VISIT DATE: 04/15/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Client left in facility unsupervised. – SUBSTANTIATED

It was reported that staff took two residents on an outing leaving Client 1 (C1) alone with Staff 1 (S1). When staff returned after 45 minutes, S1’s car was parked in a different spot from when they left. C1 told staff that S1 had left them alone in the facility for quite a while.

Client 1 stated S1 left them alone in the house for 30 – 45 minutes. Client could not recall whether S1 left the facility grounds or was out in their vehicle.

During staff interviews it was learned that staff went on an outing and when they returned S1’s car had been moved to another location on the facility property. Client informed staff that S1 had left the facility, client looked for S1’s car and it was gone.

Administrator stated C1 was unsupervised while S1 went out to their car to grab something and was out of the facility for about ten minutes, S1 never left the facility.

It was determined that S1 did leave C1 in the facility alone and unsupervised. This allegation is substantiated. A civil penalty has been assessed in the amount of $500.00 on 04/24/2025 on the attached LIC421.

Staff member verbally abuses clients in care. - SUBSTANTIATED

It was reported that Staff 1 (S1) verbally abuses clients.

Client interview revealed that S1 called them a crybaby and told them to stop throwing a temper tantrum. C1 stated that they have witnessed S1 being verbally abusive to Client 2 (C2) at Gilmore Ranch and Client 3 (C3) who lives at the Lucknow facility.

During staff interviews it was learned that staff have witnessed S1 call C2 An expletive several times. Staff witnessed S1 tell C2 to get the eff out of my kitchen, C2 was in the way, and they can’t stand C2’s r**d a**. Staff stated S1 called C3 an expletive and threatened to shove C3’s phone up their a**. Staff stated they have witnessed S1 threaten Client 4 (C4) who lives at the NVS Rawson home and told C4 he was going to punch them in the effing face and called C4 a hillbilly back wood MFer.

It was determined that S1 has a habit of being verbally abusive, vulgar, and threatening toward clients who live in multiple homes that are managed by North Valley Services. This allegation is substantiated.

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

DATE: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 59-AS-20250204165221
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: GILMORE RANCH HOME
FACILITY NUMBER: 525002590
VISIT DATE: 04/15/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Uncleared adult working at the facility – SUBSTANTIATED

It was reported that Staff 1 (S1) is not associated to the facility.

LPA reviewed a Criminal Record Background clearance report that was issued on 10/08/2024 which shows that C1 has obtained criminal background clearance. LPA reviewed personnel reports for the facility generated via Guardian. These reports were dated 02/05/2025 and 04/14/2025. Neither report shows that S1 is currently associated to the facility.

It was determined that S1 does have criminal background clearance but is not associated to the facility which is a requirement for staff to work in the facility. This allegation is substantiated. A civil penalty has been assessed in the amount of $100.00 on 04/24/2025 on the attached LIC421.

Based on interviews and evidence obtained during the investigation, the preponderance of evidence standard has been met, therefore, the above allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22), is being cited on the attached LIC9099D. Appeal rights were provided. 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: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 59-AS-20250204165221
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: GILMORE RANCH HOME
FACILITY NUMBER: 525002590
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/13/2025
Section Cited
CCR
85065(b)
1
2
3
4
5
6
7
85065(b) The licensee shall employ staff as necessary to ensure provision of care and supervision to meet client needs. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
The licensee to create a plan regarding how they will ensure qualified staff will be present at all times in the facility and will never leave a client unsupervised. Licensee shall submit this plan to LPA as proof of correction.
8
9
10
11
12
13
14
Based on interviews it was determined that a client was left in the facility alone and without supervision. This poses an immediate Health, Safety and Personal Rights risk to clients in care.
8
9
10
11
12
13
14
POC due date is 05/13/2025.
A civil penalty has been assessed in the amount of $500.00 on 04/24/2025 on the attached LIC421.
Type A
05/13/2025
Section Cited
CCR
80072(a)(1)
1
2
3
4
5
6
7
80072(a)(1) Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (1) To be accorded dignity in his/her personal relationships with staff and other persons. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee agrees to conduct training with all staff on the requirement to treat clients with dignity and respect. Licensee shall remind staff that they work for the clients and must remain professional, courteous, and respectful at all times while working in the licensed facilities. Licensee shall submit training content and signed and dated staff training sign in sheet as proof of correction to LPA as proof of correction.
8
9
10
11
12
13
14
Based on interviews the licensee failed to ensure that clients are provided dignity and respect in their personal relationships with staff. This poses an immediate Health, Safety and Personal Rights risk to clients in care.
8
9
10
11
12
13
14
POC due date is 05/13/2025.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 59-AS-20250204165221
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: GILMORE RANCH HOME
FACILITY NUMBER: 525002590
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/22/2025
Section Cited
CCR
80019(e)(3)
1
2
3
4
5
6
7
80019 (e)(3) Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 80019(f). This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee agrees to associate S1 to the facility immediately.
Proof of completion of association shall be sent to LPA.
8
9
10
11
12
13
14
Based on LPAs file review It was determined that S1 does have fingerprint clearance but is not associated to the facility. This poses a potential Health, Safety and Personal Rights risk to clients in care.
8
9
10
11
12
13
14
POC due 04/21/2025.
A civil penalty has been assessed in the amount of $100.00 on 04/24/2025 on the attached LIC421.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5