<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455002695
Report Date: 04/17/2025
Date Signed: 04/17/2025 11:16:30 AM

Unsubstantiated


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
01/14/2025 and conducted by Evaluator Ivan Avila
COMPLAINT CONTROL NUMBER: 59-AS-20250114165215
FACILITY NAME:PRS - CAPRICORN RETREATFACILITY NUMBER:
455002695
ADMINISTRATOR:PUCKETT, GRACEFACILITY TYPE:
740
ADDRESS:3292 CAPRICORN WAYTELEPHONE:
(530) 605-0922
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY:4CENSUS: 4DATE:
04/17/2025
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Grace PuckettTIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not serve residents an adequate amount of food portions
Staff left residents unsupervised
Staff did not ensure that facility appliances were repaired
Staff did not maintain a comfortable temperature for residents in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On April 17, 2025, Licensing Program Analyst, (LPA) Ivan Avila conducted an unannounced complaint investigation visit regarding the above allegations directed by the Department. LPA Avila met with Grace Puckett and explained the purpose of the visit.

During the investigation process, interviews and a records review were initiated.

LPA investigated the allegation, “Staff did not serve residents an adequate amount of food portions.” Based on interviews and observations, the facility has an adequate amount of food for the residents. Food supplies in facility were adequate per requirement. LPA could not corroborate the allegation.

----- Continued on LIC9099C -----
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
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 2
Control Number 59-AS-20250114165215
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: PRS - CAPRICORN RETREAT
FACILITY NUMBER: 455002695
VISIT DATE: 04/17/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA investigated the allegation, “Staff left residents unsupervised.” Based on interviews conducted it was stated that residents are not left alone at the facility or unsupervised for extended periods of time. Staff interviewed acknowledged that when the weather is nice, the residents are free to go in the backyard while staff observe. LPA could not corroborate the allegation.

LPA investigated the allegation, “Staff did not ensure that facility appliances were repaired.” Based on interviews and record review, two appliances were under repair. LPA observed work orders for the washer and dishwasher and parts were ordered to get them both repaired by a service company. Even though the washer was down for maintenance, the laundry was taken to another facility to get washed and staff were hand washing the dishes after meals until the dishwasher was repaired.

LPA investigated the allegation, “Staff did not maintain a comfortable temperature for residents in care.” Based on interviews and observations, the facility was at a comfortable temperature during each visit. Staff acknowledged the facility to be cold in the winter and hot in the summer and staff will adjust the temperature to a comfortable setting for the residents. LPA could not corroborate the allegation.

Based on interviews conducted and observations, the preponderance of evidence standards have not been met. Therefore, the above allegations are found to be UNSUBSTANTIATED. Findings that the complaint is Unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted, and a copy of the report was provided.

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2