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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525002755
Report Date: 05/21/2024
Date Signed: 05/21/2024 10:53:13 AM


Document Has Been Signed on 05/21/2024 10:53 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:LASSEN HOUSE SENIOR LIVINGFACILITY NUMBER:
525002755
ADMINISTRATOR:BRASWELL, NICOLEFACILITY TYPE:
740
ADDRESS:705 LUTHER RDTELEPHONE:
(530) 529-2900
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY:86CENSUS: 58DATE:
05/21/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Nicole Braswell - administratorTIME COMPLETED:
11:00 AM
NARRATIVE
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05/21/2024 10:00 AM Licensing Program Analyst Rebecca Knight conducted an unannounced case management visit and met with administrator Nicole Braswell. Today’s visit is regarding an incident that occurred on 05/20/2024 and was reported to licensing by the facility the same day.

It was reported that on 05/20/2024 am, Administrator received a call from the branch manager at a local bank regarding two checks in the amount of $5000.00 each that had been cashed by Staff 1 (S1) that were from Resident 1 (R1) account. R1 states they gifted S1 the money because S1’s had been asked to leave their apartment, and S1 needed a deposit, first and last months' rent to move into a new place. Administrator called the Red Bluff Police Department (RBPD) immediately to investigate. Officer from RBPD responded and interviewed R1 to get their side of the story. Officer then interviewed S1 to get their side of the story. Officer returned to the community and informed administrator that S1 was being charged with felony dependent/elder abuse by fraud. Officer also spoke with R1 to inform them of these charges. Employee was suspended immediately and subsequently terminated from employment.

As a result of the investigation it was determined that Staff 1 (S1) accepted a substantial amount of money from a resident in care under false pretenses which constitutes financial and mental/emotional abuse.

Based on interviews and evidence obtained during the investigation, the preponderance of evidence standard has been met, therefore, the allegation that staff financially and mentally/emotionally abused a resident is found to be SUBSTANTIATED. California Code of Regulations, (Title 22), is being cited on the attached LIC809D. Appeal rights were provided. Exit interview was conducted and the report was provided to administrator Nicole Braswell.

SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:
DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/21/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/21/2024 10:53 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827


FACILITY NAME: LASSEN HOUSE SENIOR LIVING

FACILITY NUMBER: 525002755

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 05/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/04/2024
Section Cited
CCR
87468.2(A)(8)

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Additional Personal Rights of Residents in Privately Operated Facilities (a)(8) To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement is not met as evidenced by:
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Licensee agrees to conduct staff training for all current staff regarding the facility policy of accepting gifts and gratuities of any kind from residents in care and the consequences they will face if they do so. Additionally licensee will provide EAP information for staff to access if they are in need of financial and/o remotuonal counseling resources.
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Based on document review and interviews the licensee did not protect R1 being financially abused by S1 resulting in significant financial loss to R1 as well as emotional abuse. This poses an immediate Health, Safety and Personal Rights risk to clients in care.
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Licensee shall submit staff sign in sheet as proof of correction.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:
DATE: 05/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/21/2024
LIC809 (FAS) - (06/04)
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