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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 581302894
Report Date: 12/23/2021
Date Signed: 12/23/2021 10:45:40 AM

Unsubstantiated


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
09/03/2021 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 25-AS-20210903154708
FACILITY NAME:FEATHER RIVER MANORFACILITY NUMBER:
581302894
ADMINISTRATOR:TERRY, NORAFACILITY TYPE:
740
ADDRESS:3962 WEST ELLA AVE.TELEPHONE:
(530) 743-5022
CITY:OLIVEHURSTSTATE: CAZIP CODE:
95961
CAPACITY:32CENSUS: DATE:
12/23/2021
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Scott Terry - LicenseeTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff failed to keep the facility free from pests – UNSUBSTANTIATED
INVESTIGATION FINDINGS:
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12/23/2021 11:00 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility unannounced to deliver the results of a complaint investigation. LPA met with licensee / administrator Scott Terry and explained the purpose of the visit was to deliver complaint investigation results for the above allegation. Prior to initiating the complaint investigation 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. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 mask, gloves.

During the course of the investigation LPA interviewed 1 administrator, 2 staff, and 2 clients. LPA attempted to interview an additional 4 staff however, these staff persons did not return LPA’s telephone calls. LPA reviewed the following documents: Staff list with telephone numbers, invoice for pest control supplies, invoice for new mattresses and box springs, roster of facility clients/residents.
Continued on LIC9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rayna L Bryson
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 25-AS-20210903154708
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: FEATHER RIVER MANOR
FACILITY NUMBER: 581302894
VISIT DATE: 12/23/2021
NARRATIVE
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Staff failed to keep the facility free from pests – UNSUBSTANTIATED

It was alleged that Staff failed to keep the facility free from pests.



The licensee stated the last time the facility had a bed bug infestation was a few months ago. The licensee stated they treat the facility once a month for bedbugs, have placed mattress covers on all of the beds, and replaced the two beds in the room where the last bed bug outbreak occurred.

During client interviews C1 stated the last time they saw bed bugs in the facility was a few months ago. C2 stated they had never seen bed bugs in the facility. During staff interviews S1 stated the facility first had bed bugs in 2018 but thought the licensee got rid of them. S4 stated they never saw any bed bugs. S1 stated the licensee changed the mattresses and bought new bedding and beds. S1 stated the licensee sprays for bed bugs and noted that they even took the base boards off to get rid of them.

During LPA’s tour of the facility C1 stated they had a bed bug on their arm the previous night. LPA Knight then observed the licensee remove C1’s bedspread and inspect for bedbugs, none were found. The licensee then removed the sheets and inspected the bedbug cover. No bed bugs were found. LPA Knight was present during the inspection and did not observe any bed bugs.

Document review included a receipt from a home improvement store that included 2 gallons of bed bug spray which were purchased on 9/08/2021. A receipt from a local home furnishings store showed the purchase of 2 twin size mattress and box spring sets were purchased for the facility on 07/03/2021. These purchases are consistent with the administrator’s statement of fogging and spraying the facility for bed bugs and purchasing new mattresses for the afflicted client room.

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 licensee /administrator Scott Terry. No deficiencies were cited on today’s date.

SUPERVISORS NAME: Rayna L Bryson
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2