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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 312700996
Report Date: 12/22/2022
Date Signed: 12/22/2022 11:33:43 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 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
10/10/2022 and conducted by Evaluator Melissa Parks
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20221010084501
FACILITY NAME:WELLQUEST GRANITE BAY TENANTCO LLCFACILITY NUMBER:
312700996
ADMINISTRATOR:MANOMHEHRI, PARIFACILITY TYPE:
740
ADDRESS:9747 SIERRA COLLEGE BLVDTELEPHONE:
(916) 864-9800
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY:135CENSUS: 101DATE:
12/22/2022
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:PARI MANOUCHEHRITIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Facility does not make dangerous items inaccessible to residents
INVESTIGATION FINDINGS:
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LPA Parks arrived on Thursday December 22, 2022 to conclude the investigation regarding the above allegation. Prior to 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; LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask.

Throughout the course of the investigation, LPA interviewed staff including Administrator, Memory Care Director, Business Office Director, med techs, caregivers, and Maintenance Director. Additionally, LPA toured common areas and apartments in Memory Care. LPA reviewed Physician Reports (LIC602) for R1-R3.

Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
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 6
Control Number 25-AS-20221010084501
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: WELLQUEST GRANITE BAY TENANTCO LLC
FACILITY NUMBER: 312700996
VISIT DATE: 12/22/2022
NARRATIVE
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LPA observed a locked drawer in resident bathrooms to lock up hygiene items. LPA learned through interview that employees have observed, at times, not all items locked up. When LPA toured memory care with the Memory Care Director, she observed unlocked hygiene and grooming items in apartments 163, 168, and 176(pictures taken). Based on the LIC602 of R2, resident is at risk if allowed direct access to personal grooming and hygiene items. Therefore, the allegation that the facility does not make dangerous items inaccessible to residents is SUBSTANTIATED.
As a result of this investigation, LPA finds the allegation to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Deficiencies cited on 9099-D. Appeal rights were printed and given.

Exit interview conducted. A copy of this report was left at the facility.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 25-AS-20221010084501
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: WELLQUEST GRANITE BAY TENANTCO LLC
FACILITY NUMBER: 312700996
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/23/2022
Section Cited
CCR
87705(g)(1)
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87705 Care of Persons with Dementia
(g) As required by Section 87468(a)(12), residents with dementia shall be allowed to keep personal grooming and hygiene items in their own possession, unless there is evidence to substantiate that the resident cannot safely manage the items.
(1) Evidence means documentation from the resident’s physician that the resident is at risk if allowed direct access to personal grooming and hygiene items.
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Administrator will provide LPA with scheduled date and time of training
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This requirement was not met based by interview, documentation, and observation of grooming and hygiene items not locked and accessible to residents with Dementia. R1, based on her 602, was at risk if allowed access to hygiene and grooming items. This poses an immediate threat to the health an safety of clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 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
10/10/2022 and conducted by Evaluator Melissa Parks
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20221010084501

FACILITY NAME:WELLQUEST GRANITE BAY TENANTCO LLCFACILITY NUMBER:
312700996
ADMINISTRATOR:MANOMHEHRI, PARIFACILITY TYPE:
740
ADDRESS:9747 SIERRA COLLEGE BLVDTELEPHONE:
(916) 864-9800
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY:135CENSUS: DATE:
12/22/2022
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:PARI MANOUCHEHRITIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Facility staff are not trained.
Facility is not accurately and timely dispensing medications to residents
Facility is not accurately maintaining residents' records.
Facility is not keeping residents' personal information confidential.
Facility is not maintained clean and sanitary.
Facility feeds residents’ inappropriate foods.
Facility does not toilet residents on a regular basis.
Facility does not bathe residents on a regular basis.
Facility does not have sufficient staff to care for the residents.
INVESTIGATION FINDINGS:
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LPA Parks arrived on Thursday December 22, 2022 to conclude the investigation regarding the above allegations. Prior to 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; LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask.

Throughout the course of the investigation, LPA interviewed staff including Administrator, Memory Care Director, Business Office Director, med techs, caregivers, and Maintenance Director. Additionally, LPA toured common areas and apartments in Memory Care. LPA obtained the following documents: training records for S1, staff roster, and postings regarding meals for R4. On two separate visits (10/17/22 and 12/8/2022), LPA toured the Memory Care unit and observed cleanliness of common areas, dining room, and random apartments. Additionally, LPA observed the physical appearance of residents.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 25-AS-20221010084501
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: WELLQUEST GRANITE BAY TENANTCO LLC
FACILITY NUMBER: 312700996
VISIT DATE: 12/22/2022
NARRATIVE
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LPA reviewed training records for the Resident Care Coordinator. Based on the records, LPA has determined that this staff is sufficiently trained to administer medications. Through interview, LPA learned that the RCC will substitute as a med tech when there is a gap in the schedule. RCC will do this in memory care and on the assisted living side of the facility.

Based on limited information given in the complaint, LPA was unable to specifically investigate the allegations: facility is not accurately and timely dispensing medications to residents and facility is not accurately maintaining resident records. However, med techs interviewed stated that if a medication was late or not given, staff are to write a reason why on QMar. All staff interviewed stated that there have not been any occurrences of medications being given untimely or inaccurately.

All staff interviewed acknowledged that the facility utilizes two radio channels to communicate. Channel 1 is for all staff to hear, only resident apartments are used, no specific or confidential information is given. If two staff members wish to have a semi-private communication, they change to channel 2. At this point, only the two staff members can hear the communication. All staff interviewed stated that they have not heard any resident personal information communicated over the radio.

During both tours of the memory care unit, LPA observed the common areas to be clean and orderly (pictures taken). The dining room appeared to be clean and sanitized (pictures taken). LPA observed the following in resident apartments: beds made, rooms organized and bathrooms tidy (pictures taken).
LPA discussed R4 with staff. All memory care staff that were interviewed acknowledged that they follow a list of foods for R4 that was provided by their family. All staff interviewed stated that R4 is offered entrees for each meal and dessert. No interviews acknowledged that R4 is only provided sweets or desserts for meals.
LPA discussed the staffing schedule with the Administrator and Memory Care Director. All staff interviewed stated that they are sufficiently staffed to meet the resident’s needs. This facility utilizes a staffing agency to assist with any staffing shortages. Additionally, all staff acknowledged that if residents are on a bathing or toileting schedule, staff will follow this schedule. If a resident refuses to be toileted or showered, staff will try again later in the shift. The memory care unit is staffed as follows: AM shift: 1 med tech, 3 caregivers, activity director; PM shift: 1 med tech, 3 caregivers; NOC shift: 1 med tech, 2 caregivers. Additionally, the assisted living staff will help memory care as needed.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 6
Control Number 25-AS-20221010084501
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: WELLQUEST GRANITE BAY TENANTCO LLC
FACILITY NUMBER: 312700996
VISIT DATE: 12/22/2022
NARRATIVE
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Based on the evidence provided, the preponderance of evidence standards was not met, therefore, the above allegations are found to be UNFOUNDED. An unfounded allegation means that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview conducted. A copy of this report was left at the facility
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 6