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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 03:03:27 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
04/07/2021 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20210407093718

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:
02:15 PM
MET WITH:Administrator Diana MoreciTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Resident sustained an injury while in care.
Resident's hygiene needs are not being met.
Staff made inappropriate comments towards resident's.
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 (C1) Valley Mountain Regional Center Individual Program Plan (IPP) dated 6/11/2019 states that C1 has sprained, twisted and fractured C1’s left ankle on several occasions. C1 wear’s a ankle brace at all time when out and walking around. During interviews it was told that C1 does have unwitnessed falls and reports to staff when C1 falls.
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 3
Control Number 27-AS-20210407093718
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 with Staff and records review. Client’s (C1) Valley Mountain Regional Center Individual Program Plan (IPP) dated 6/11/2019 states that C1 is prone to skin rashes in the folds of skin and apron area. Staff are to assist C1 to apply cream to the areas that are prone to rash. Through interviews with staff and witness, C1 often denies staff’s help on applying cream, and when C1 denies help the facility documents the attempts.

Through interviews with Staff do have to speak directly or loud with Client’s in care at the facility. If Staff may offend Client’s in care, but Staff have not heard other Staff or Clients say anything derogatory to each other. If Staff would have heard other staff talking derogatory to clients in care, they would notify management.

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. Exit interview was conducted with Administrator Diana Moreci and a copy of report was left.
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 3