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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 315920040
Report Date: 10/15/2025
Date Signed: 10/15/2025 10:55:15 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/25/2025 and conducted by Evaluator Cassandra Mikkelson
COMPLAINT CONTROL NUMBER: 59-AS-20250825141240
FACILITY NAME:SIERRA RIDGE SENIOR LIVINGFACILITY NUMBER:
315920040
ADMINISTRATOR:ALEXIS THACKERFACILITY TYPE:
740
ADDRESS:3265 BLUE OAKS DRIVETELEPHONE:
(530) 718-1553
CITY:AUBURNSTATE: CAZIP CODE:
95602
CAPACITY:65CENSUS: 50DATE:
10/15/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Tony SellersTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Staff did not provide medication assistance to resident in care
Staff did not provide proper meals to residents in care
Staff did not prevent resident from engaging in inappropriate behavior in residents' rooms
Staff did not provide shower assistance to resident in care
Staff did not properly report resident's incident
Hygiene supplies are not readily available to residents in care
Staff left resident in care in soiled clothes for an extended period of time
INVESTIGATION FINDINGS:
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Licensed Program Analyst (LPAs) Cassandra Mikkelson and Kerry Hiratsuka arrived at the facility unannounced and met with Tony Sellers to deliver findings for the above complaint allegation.

During the investigation, LPA conducted interviews, conducted a tour of the facility, and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

*** Report continued on 9099-C***
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025
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 3
Control Number 59-AS-20250825141240
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SIERRA RIDGE SENIOR LIVING
FACILITY NUMBER: 315920040
VISIT DATE: 10/15/2025
NARRATIVE
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Staff did not provide medication assistance to resident in care

Interviews with staff indicated that they follow medication assistance to residents who are taking medications. Staff assist with making sure each resident receives the correct medication on time each day. Observations of medication logs indicated that residents are receiving their correct medications on time each day. Medication lists were logged with correct doses and amounts as prescribed by their physicians. Therefore, the allegation staff did not provide medication assistance to residents in care is unfounded.

Staff did not provide proper meals to residents in care

Interviews with staff indicated that there was a menu that was followed by kitchen staff for each meal. Interviews with residents indicated that they like the food that is served and that there is a good variety of food options. Observations of the weekly menu indicated that there is a variety of meal options each day with good nutritional value. Therefore, the allegation staff did not provide proper meals to residents in care is unfounded.

Staff did not prevent resident from engaging in inappropriate behavior in residents' rooms

Interviews conducted indicated that the staff monitor and will try to redirect residents as needed. Staff indicate in their charting/progress notes on if a resident is engaging in certain behaviors so all staff are aware. Title 22 regulations do not indicate a staffing requirement and do not require 24/7 monitoring. The facility has the appropriate number of staff to meet the residents needs and give proper supervision. Therefore, the allegation staff did not prevent resident from engaging in inappropriate behavior in residents’ rooms is unfounded.

Staff did not provide shower assistance to resident in care

Records reviewed indicated that staff are providing shower assistance to residents in care. Staff are documenting showers that are given and when a shower is refused after multiple attempts. Interviews conducted indicated that staff are assisting with showers and attempting more than once to give a resident a shower if they refuse the first time. Therefore, the allegation staff did not provide shower assistance to resident in care is unfounded.

**Continued on 9099-C2 page**

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 59-AS-20250825141240
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SIERRA RIDGE SENIOR LIVING
FACILITY NUMBER: 315920040
VISIT DATE: 10/15/2025
NARRATIVE
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Staff did not properly report resident's incident

Interviews conducted indicated staff document in each resident’s chart if there is an incident that has occurred. Staff protocol is that emergency services are called if there is a fall or unwitnessed injury and then resident’s responsible party (RP) is called to inform of incident. Records reviewed indicated that incidents with or without injury are documented in each resident progress notes and alert charting is indicated for closer monitoring. Therefore, the allegation staff did not properly report resident’s incident is unfounded.

Hygiene supplies are not readily available to residents in care

Interviews conducted indicated that staff are providing each resident room with the necessary hygiene supplies needed. Observations of resident rooms indicated that rooms are stocked with necessary hygiene items. Staff were also checking resident rooms for hygiene items to ensure residents had what they needed for proper hygiene. Therefore, the allegation hygiene supplies are not readily available to residents in care is unfounded.

Staff left resident in care in soiled clothes for an extended period of time

Interviews conducted indicated that residents are changed based on their incontinence needs and level of assistance needed. Records reviewed indicated that it is listed in the facility system the level of incontinence and what assistance is required by facility staff. Observations indicated staff assisting residents with trips to the restroom and incontinence needs as needed or requested. Therefore, the allegation staff left resident in care in soiled clothes for an extended period of time is unfounded.

Based on records reviewed and interviews, LPA finds the above allegations to be UNFOUNDED- meaning that the allegations were false, could not have happened and/or is without reasonable basis. Exit interview conducted. Copy of report was given to facility.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3