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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455002695
Report Date: 06/09/2025
Date Signed: 06/09/2025 11:07:16 AM

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
04/02/2025 and conducted by Evaluator Ivan Avila
COMPLAINT CONTROL NUMBER: 59-AS-20250402080642
FACILITY NAME:PRS - CAPRICORN RETREATFACILITY NUMBER:
455002695
ADMINISTRATOR:SCHLOTTMAN, LAURIEFACILITY TYPE:
740
ADDRESS:3292 CAPRICORN WAYTELEPHONE:
(530) 605-0922
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY:4CENSUS: 4DATE:
06/09/2025
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Dwight McGuireTIME COMPLETED:
11:25 AM
ALLEGATION(S):
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Staff are not adhering to food service requirement
Staff do not treat residents with dignity and respect
Staff are not providing residents with adequate hand washing supplies
INVESTIGATION FINDINGS:
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On June 09, 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 Dwight McGuire and explained the purpose of the visit.

LPA investigated the allegation, “Staff are not adhering to food service requirements.” During visit conducted on April 8, 2025, LPA observed multiple food items in the kitchen refrigerator to be uncovered and not labeled. LPA observed raw chicken uncovered on the middle rack. Directly underneath the raw chicken was an uncovered salad bowl on the bottom shelf. Staff removed the salad bowl during LPA's inspection. As a result of LPA's initial visit to the facility, LPA determined that the facility was not adhering to food service requirements prior to visit conducted on April 8, 2025. Additionally, interviews conducted stated multiple staff have served residents spoiled food during meals.

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

DATE: 06/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2025
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 6
Control Number 59-AS-20250402080642
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: 06/09/2025
NARRATIVE
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LPA investigated the allegation, “Staff do not treat residents with dignity and respect.” Based on interviews conducted it was indicated that multiple staff would tell R1 they would use the hoyer lift to get R1 out of bed, knowingly R1 is afraid of the lift. Interviews revealed staff suggest the use of the hoyer lift as a motivational tool to get R1 out of bed. Interviews indicated that staff would yell at R1 when he did not want to get out of bed in the mornings, which negatively impacts resident's sense of well-being.

LPA investigated the allegation, “Staff are not providing residents with adequate hand washing supplies.” During visit conducted on April 8, 2025, LPA observed two of two facility bathrooms did not have paper towels and soap. Staff stated they would provide paper towels for both bathrooms during LPA’s inspection. Additionally, during visit conducted on April 17, 2025, LPA observed both bathrooms still did not have paper towels. As a result of LPA’s visits on April 8, 2025, and April 17, 2025, LPA determined that the facility was not providing adequate hand washing supplies. Interviews also indicated the facility had been running out of hand soap on multiple occasions.

Based on LPAs observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, and the California Health and Safety Code are cited on the attached LIC9099-D.

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

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

DATE: 06/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 59-AS-20250402080642
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/23/2025
Section Cited
CCR
87555(b)(15)
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87555(b)(15) The following food service requirements shall apply: All persons engaged in food preparation and service shall observe personal hygiene and food services sanitation practices which protect the food from contamination. This requirement is not met as evidenced by:
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Facility will ensure that all food items on the premises are covered and labeled to prevent contamination. Licensee will conduct training for safe food practices and for staff to properly identify spoiled food and discard before use. Licensee will email LPA the training by POC due date: 06/23/2025
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Based on LPA's observations, the facility did not ensure food to be protected from contamination when multiple food items were left uncovered, which poses a potential health, safety, and personal rights violation to the residents in care.
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Type B
06/23/2025
Section Cited
CCR
87468.1(a)(1)
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87468.1(a)(1) Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by:
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The Licensee agrees to provide training to all staff regarding the personal rights of residents residing in a facility. Licensee will email LPA the taining by POC due date: 06/23/2025
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Based on interviews, the facility did not protect the personal rights of R1 when staff yell at R1 by telling R1 they will use the hoyer lift as intimidation to get R1 out of bed, which poses a potential health, safety, and personal rights violation 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: Anthony Perez
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 59-AS-20250402080642
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/23/2025
Section Cited
CCR
87307(a)(3)(D)
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87307(a)(3)(D) The following provisions shall apply:...supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident....such as soap and toilet paper. This requirement is not met as evidenced by:
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Licensee will ensure to have adequeate hand washing soap and paper towels at the facility. Licensee will come up with a plan to ensure a checklist will be developed to restock the hand soap and paper towels. Licensee will email LPA the training by POC due date: 06/23/2025
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Based on LPA's observations, the facility did not provide paper towels, soap to residents and staff to maintain an adequate hygiene practice, which poses a potential health, safety, and personal rights violation 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: Anthony Perez
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
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
04/02/2025 and conducted by Evaluator Ivan Avila
COMPLAINT CONTROL NUMBER: 59-AS-20250402080642

FACILITY NAME:PRS - CAPRICORN RETREATFACILITY NUMBER:
455002695
ADMINISTRATOR:SCHLOTTMAN, LAURIEFACILITY TYPE:
740
ADDRESS:3292 CAPRICORN WAYTELEPHONE:
(530) 605-0922
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY:4CENSUS: 4DATE:
06/09/2025
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Dwight McGuireTIME COMPLETED:
11:25 AM
ALLEGATION(S):
1
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3
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Staff are not mitigating the spread of infectious outbreaks in the facility
Staff do not maintain resident areas clean and orderly
Staff do not seek timely medical attention for residents
Licensee does not ensure enough staff to meet residents needs
Staff are not meeting resident bathing needs
INVESTIGATION FINDINGS:
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On June 09, 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 Dwight McGuire and explained the purpose of the visit.

LPA investigated the allegation, “Staff are not mitigating the spread of infectious outbreaks in the facility.” Based on interviews it was indicated R1 did not notifying anyone they were sick prior to leaving the facility to go to day program. R1 went to day program and did not tell facility staff they were sick. Facility staff picked up R1 from the day program when day program staff called the facility to let them know R1 was sick. R1 was brought home and monitored until they felt better to return to program after a few days. 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: 06/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 59-AS-20250402080642
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: 06/09/2025
NARRATIVE
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LPA investigated the allegation, “Staff do not maintain resident areas clean and orderly.” Based on interviews and observations, LPA observed that the facility was relatively clean and organized. LPA toured resident rooms which also appeared to be clean and orderly. No interviews revealed that the facility is kept unsanitary or that cleaning duties are neglected. Staff stated that, at times, they become busy or are behind schedule, but that they work together to accomplish cleaning tasks.

LPA investigated the allegation, “Staff do not seek timely medical attention for residents.” Based on interviews conducted that medical assistance had been sought out when facility staff found out about R1’s sores. Interviews indicated that facility policy is that when it is determined a resident needs emergency medical attention, the facility initiates emergency services. Staff made appointments to address R1’s sores. The Department was unable to determine through interviews and documentation if the facility failed to seek timely medical attention for R1.

LPA investigated the allegation, “Licensee does not ensure enough staff to meet residents needs.” Based on interviews and observations, evidence was not found to support that there were insufficient staff to meet the needs of resident identified care needs. Interviews indicated there are usually two staff working on each shift. LPA observed during multiple visits two staff members working at the facility during the time of the investigation.

LPA investigated the allegation, “Staff are not meeting resident bathing needs.” Based on interviews conducted, staff indicated that residents receive sufficient care with bathing, grooming, and hygiene. Staff interviews revealed that residents receive showers unless they refuse. If a resident refuses the staff will make several attempts to see if they want to shower.

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.

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

DATE: 06/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6