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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525002755
Report Date: 05/02/2022
Date Signed: 05/02/2022 01:02:35 PM


Document Has Been Signed on 05/02/2022 01:02 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: 68DATE:
05/02/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Sue Todd - Executive DirectorTIME COMPLETED:
01:30 PM
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05/02/2022 12:30 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 conduct a case management investigation. 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: surgical mask, gloves. LPA was screened by Sue Todd.

Today's meeting concerns an incident report that was received from the facility on 03/25/2022 regarding an incident that occurred at the facility on 03/24/2022. It was reported that on 3/24/2022 Resident 1 (R1) reported that they were missing “about $1,000.00” from their room. R1 states they routinely keep cash in an envelope in a drawer in a cabinet in their room. R1 states they got about $2,000 in cash out from the bank and they give cash to Visiting Angels when they do R1’s shopping. R1 thought they looked at the money about 1 week prior to the incident report. Two care staff and R1 checked R1’s room and found three envelopes with some cash in them.

The facility made a report to Red Bluff Police department who came and took a report, R1 was vague with dates and times during the interview, no further action was taken.

The facility offered a closed circuit camera for R1 to be able to monitor their room but the resident declined. R1 has a locking cabinet in their bathroom that only R1 has a key for. It was recommended to R1 that they lock up their cash and valuables and R1 agreed to try that.

LPA inpected R1's room and observed the locking cabinet. Verified with R1 that they are locking their valuables up in the cabinet.

No deficiencies cited. Exit interview conducted and a copy of the report was emailed to Sue Todd.

SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 895-4356
LICENSING EVALUATOR SIGNATURE:
DATE: 05/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2022
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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