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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525002755
Report Date: 02/22/2022
Date Signed: 02/22/2022 12:50:32 PM


Document Has Been Signed on 02/22/2022 12:50 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:LASSEN HOUSE SENIOR LIVINGFACILITY NUMBER:
525002755
ADMINISTRATOR:TODD, SUSANFACILITY TYPE:
740
ADDRESS:705 LUTHER RDTELEPHONE:
(530) 529-2900
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY:86CENSUS: 69DATE:
02/22/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Sue Todd - Executive DirectorTIME COMPLETED:
01:00 PM
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02/22/2022 12:00 PM Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with Executive Director Sue Todd. The purpose of this visit was to discuss staffing schedules pertaining to a recent non-compliance meeting. 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: N95 Mask, gloves.

The facility has been reporting weekly staffing schedules to LPA Knight since the end of December 2021. Review of these weekly staffing schedules showed no significant staffing issues.

Ms. Todd stated When we started the reporting phase we had 42 employees. We ran an ad for on call staff and over time back filled our full time openings. We are still implementing 2 med techs for the day and evening shifts. The night shift has 1 med tech, but we have 1 additional staff that comes in at 4:00 AM for a total of three staff for that shift, which is when the residents start waking up and may require more assistance. We hired 1 staff from a staffing agency to cover 4 shifts because we were Covid positive and down staff for the evening shift. This allowed us to give our staff a break from working additional overtime. We have not had any incidents of concern.

No deficiencies were cited as a result of today's visit.
SUPERVISOR'S NAME: Rayna L BrysonTELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 895-4356
LICENSING EVALUATOR SIGNATURE:
DATE: 02/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2022
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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