525002806-10-28-2021-25-AS-KHOS-C8KPH9-20211108101935

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 525002806
Report Date: 10/28/2021
Date Signed: 10/28/2021 01:12:52 PM

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
06/18/2021 and conducted by Evaluator Rebecca Knight

COMPLAINT CONTROL NUMBER: 25-AS-20210618110753

FACILITY NAME:	GILMORE PLACE		FACILITY NUMBER:	525002806
ADMINISTRATOR:	WILCOX, JULIE		FACILITY TYPE:	740
ADDRESS:	70 GILMORE ROAD		TELEPHONE:	(530) 727-9293
CITY:	RED BLUFF	STATE: CA	ZIP CODE:	96080
CAPACITY:	22	CENSUS: 20	DATE:	10/28/2021
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Micah Carey - administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff do not wear masks or gloves.
Facility has pests.
Facility staff does not handle residents' medications and food in a sanitary manner.
Facility is in disrepair/leak in kitchen.

INVESTIGATION FINDINGS:

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10/28/2021 1:30 PM Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with Julie Wilcox administrator for the facility. 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: Surgical Mask, gloves.

Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 895-4356
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 25-AS-20210618110753

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: GILMORE PLACE	FACILITY NUMBER: 525002806
	VISIT DATE: 10/28/2021

NARRATIVE

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During the course of the investigation LPA interviewed 1 administrator, 1 maintenance staff, and 4 care staff. LPA obtained the following documents to investigate the above allegations: Facility Food Handling & Safety policy, Medication Handling Policy, Visitor policy, pest control invoices, receipt for repair supplies, staff list with contact information.

Allegation: Staff do not wear masks or gloves. - UNSUBSTANTIATED.

During LPA Knight’s visit to the facility on 7/12/2021 to conduct an Infection Control Annual Inspection LPA observed all staff who were in the facility wearing face masks. Staff are not required to wear gloves at all times in the facility.

Staff interviews revealed that all staff are aware that they are required to wear masks at all times while they are in the facility. Staff confirmed that they are all wearing masks while they are inside of the facility at all times.

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

Allegation: Facility has pests. - UNSUBSTANTIATED.

Review of invoices from T. Brooks Pest Control revealed that the facility has regular pest control service and additional bed bug service treatments. Administrator stated the facility covered all of the mattresses with bed bug protectors. The pest control company comes in twice a month and treats the affected rooms, and staff goes through the facility every week with housekeeping to inspect for bedbugs.

Staff interviews confirmed that the facility does have an issue with bed bugs, and that the facility has regular pest control services.

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 LIC9099C

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 895-4356
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021

LIC9099 (FAS) - (06/04)

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Control Number 25-AS-20210618110753

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: GILMORE PLACE	FACILITY NUMBER: 525002806
	VISIT DATE: 10/28/2021

NARRATIVE

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Allegation: Facility staff does not handle residents' medications and food in a sanitary manner. - UNSUBSTANTIATED.

Review of the facility’s Food Handling & Safety policy revealed that the facility trains staff to wash their hands with warm soap and water for 20 seconds and to follow the “no bare hands” rule which teaches that an individual’s bare skin should not come into contact with ready-to-eat foods. Instead, alternative procedures should be practiced, such as using tongs, spatulas, deli tissue, or wearing clean, single-use gloves.

It was learned during staff interviews that all staff sanitize their hands and wear gloves before preparing or serving food.

Review of the facility’s Medication Handling Instructions revealed that staff are trained to first wash their hands for at least 20 seconds at the start of a medication pass and wear sanitary gloves although wearing gloves is not required by CCLD regulations. CCLD requirements do not include the use of gloves when handling medications, the requirement is to ensure the area where staff handle medications is clean and sanitary.

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

An exit interview was conducted. A copy of the report was emailed to facility administrator Micah Carey. No deficiencies were cited on today’s date.

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Rebecca Knight	TELEPHONE: (530) 895-4356
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021

LIC9099 (FAS) - (06/04)

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