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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455002677
Report Date: 08/14/2025
Date Signed: 08/14/2025 02:17:20 PM

Substantiated


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
04/03/2025 and conducted by Evaluator Sarah Benson
COMPLAINT CONTROL NUMBER: 59-AS-20250403092452
FACILITY NAME:HALLMARK NORTHFACILITY NUMBER:
455002677
ADMINISTRATOR:SINGH, GURMEELFACILITY TYPE:
740
ADDRESS:920 HALLMARK DRTELEPHONE:
(530) 243-0147
CITY:REDDINGSTATE: CAZIP CODE:
96001
CAPACITY:6CENSUS: 0DATE:
08/14/2025
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Facility Manager Michael MoodieTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Medication management.
INVESTIGATION FINDINGS:
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On 08/14/2025 at 1:45PM Licensing Program Analyst (LPA) Sarah Benson, conducted an unannounced visit and met with Facility Manager Michael Moodie. The purpose of this visit was to deliver complaint findings submitted on 4-3-25. During todays visit it was discovered no residents are in care at this time. The residents were moved to Westside Assisted Living and Redbud Care Home.

During the complaint investigation staff interviews were attempted and the following documents were reviewed: staff schedules, staff list with telephone numbers, residents admission agreements, medical records, hospital visits, medication records, resident daily logs and incident reports.



Continued on LIC9099C & LIC9099D
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
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-20250403092452
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: HALLMARK NORTH
FACILITY NUMBER: 455002677
VISIT DATE: 08/14/2025
NARRATIVE
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LPA attempted staff interviews multiple times with no success. Document review revealed, on 3-24-25 at 7:30PM staff reported R1’s 7:00AM medication was still in medication box and not given. Document review revealed on 3-25-25 R1’s 8:00PM medication was given at 8:00 AM. Document review revealed R1’s 8:00AM medication was given at 1:00PM. Document review revealed no incident reports were submitted to Licensing concerning medication errors in March 2025.

Based on investigation observations, record review(s) and interviews which were conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, (Title 22), is cited on the attached LIC 9099D. Appeal rights were explained and provided to the facility representative listed above and exit interview conducted. If any of the cited deficiencies are not corrected by the noted due date, civil penalties may be assessed.



SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 59-AS-20250403092452
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: HALLMARK NORTH
FACILITY NUMBER: 455002677
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/15/2025
Section Cited
CCR
87465(a)4)
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Incidental Medical and Dental Care. (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:
(4) The licensee shall assist residents with self-administered medications as needed.
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Administrator will have all staff administering medicaion receive training from a professional.
Administrator will perform medicaion checks bi-weekly.
Administrator will send a copy with staff signatures and topices covered to LPA.
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This requirement is not met as exidenced by: Based on observatin and interview of Staff the licensee did not ensure residents are received medicaion as prescribed. This poses a potential health and safety risk to the residents 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: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3