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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700299
Report Date: 10/31/2022
Date Signed: 10/31/2022 01:14:05 PM

Unsubstantiated


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
10/07/2022 and conducted by Evaluator Lavinia Muscan
COMPLAINT CONTROL NUMBER: 25-AS-20221007135203
FACILITY NAME:HAPPY MEMORIES SENIOR CAREFACILITY NUMBER:
342700299
ADMINISTRATOR:CHIS, CARMENFACILITY TYPE:
740
ADDRESS:255 CIMMARON CIRCLETELEPHONE:
(707) 365-6353
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:6CENSUS: 6DATE:
10/31/2022
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator, Solomon ChisTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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9
Staff not following infection control plans.
INVESTIGATION FINDINGS:
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5
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7
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13
On 10/31/22, Licensing Program Analysts (LPA) Lavinia Muscan arrived at the facility unannounced to deliver complaint findings into the allegations listed above and met with Administrator Solomon Chis. Prior to 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 hand sanitizer was applied before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask.

During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

**Report continued on 9099-C**
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2022
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 3
Control Number 25-AS-20221007135203
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: HAPPY MEMORIES SENIOR CARE
FACILITY NUMBER: 342700299
VISIT DATE: 10/31/2022
NARRATIVE
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Staff not following infection control plans.

LPA observed staff wearing mask on 10/11/2022. LPA asked staff if they wear their mask daily. Staff stated that they do, except when they eat. It was observed on random visits that staff do wear masks. It could not be proven that staff did not follow the COVID 19 mask guidance. This agency has investigated the above listed allegation(s). Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred therefore, we have found the allegation(s) to be UNSUBSTANTIATED.

Exit interview was conducted with Administrator and a copy of this report was provided to the facility. The signature of Administrator on these forms acknowledges receipt of these documents.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
10/07/2022 and conducted by Evaluator Lavinia Muscan
COMPLAINT CONTROL NUMBER: 25-AS-20221007135203

FACILITY NAME:HAPPY MEMORIES SENIOR CAREFACILITY NUMBER:
342700299
ADMINISTRATOR:CHIS, CARMENFACILITY TYPE:
740
ADDRESS:255 CIMMARON CIRCLETELEPHONE:
(707) 365-6353
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:6CENSUS: 6DATE:
10/31/2022
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator, Solomon ChisTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff not being able to communicate with emergency personnel.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Staff not being able to communicate with emergency personnel.
LPA Muscan was able to interview the staff at the facility. After further review, LPA was able to interview staff (S1), who displayed an ability to communicate and answer basic questions. On 10/11/22 LPA Muscan set a scenario for the Licensee and S1 to play out. It was an on-the-spot scenario. Licensee played the 911 operator and S1 played themselves. S1 was able to show that S1 can call 911 and answer basic questions from the operator. S1 was also able to show that S1 can keep residents safe until medical personnel arrive. Language is not observed to be a barrier at the facility. Additionally, S1 is enrolled in English classes to further enhance S1s vocabulary. Emergency evacuation courses were also taken by S1. This agency has investigated the complaint alleging (Staff not being able to communicate with emergency personnel). We have found the complaint was UNFOUNDED, meaning that the allegation is false, could not have happened, and/or is without a reasonable basis.
Exit interview was conducted with Administrator and a copy of this report was provided to the facility. The signature of Administrator on these forms acknowledges receipt of these documents.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3