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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 550307827
Report Date: 10/21/2021
Date Signed: 10/21/2021 03:06:11 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/12/2021 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20210312110312

FACILITY NAME:SIERRA FOOTHILLS RESIDENTIAL CARE, INC.FACILITY NUMBER:
550307827
ADMINISTRATOR:DIANA MORECIFACILITY TYPE:
735
ADDRESS:20470 BAY MEADOWS DRIVETELEPHONE:
(209) 533-3708
CITY:SONORASTATE: CAZIP CODE:
95370
CAPACITY:14CENSUS: 13DATE:
10/21/2021
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Administrator Diana MoreciTIME COMPLETED:
02:10 PM
ALLEGATION(S):
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Resident sustained an injury while in care
Resident's files are not accurate
INVESTIGATION FINDINGS:
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A complaint investigation regarding the above allegations was completed by LPA Jason Lund.

Through interviews with Staff and records review. Client’s (C3) Valley Mountain Regional Center Individual Program Plan (IPP) dated 6/11/2019 states that C3 is prone to skin rashes in the folds of skin and apron area. Staff are to assist C3 to apply cream to the areas that are prone to rash. Through interviews with staff and witness, C3 often denies staff’s help on applying cream, and when C3 denies help the facility documents the attempts.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 27-AS-20210312110312
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: SIERRA FOOTHILLS RESIDENTIAL CARE, INC.
FACILITY NUMBER: 550307827
VISIT DATE: 10/21/2021
NARRATIVE
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Through interviews and records review from the facility. In 2016 Client (C4) had an injury while at the facility to C4’s upper body that eventually took surgery to remove the excess skin from the injury. The facility followed the plan of care and C4 has since recovered from the injury. C4’s Valley Mountain Regional Center Individual Program Plan (IPP) dated 9/20/2018 is diagnosed Impulse Control Disorder, Depression and Anxiety for which C4 is following C4’s plan of care.

Through interviews with staff, witnesses and records review the facility has had history of complaints substantiated for medication errors and not giving the clients medication in a timely manner. It is unclear at the time of the complaint if there where are any such records. It is the facility responsibility to report any inaccuracies to Valley Mountain Regional Center and Community Care Licensing (CCL).

Although the allegation may be valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4