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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 525002755
Report Date: 11/18/2025
Date Signed: 11/18/2025 03:15:49 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
10/14/2025 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 59-AS-20251014164638
FACILITY NAME:LASSEN HOUSE SENIOR LIVINGFACILITY NUMBER:
525002755
ADMINISTRATOR:BRASWELL, NICOLEFACILITY TYPE:
740
ADDRESS:705 LUTHER RDTELEPHONE:
(530) 529-2900
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY:86CENSUS: 52DATE:
11/18/2025
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Rosanna Larsen-Burrill Business Services DirectorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility staff did not maintain complete and accurate residents' records. - SUBSTANTIATED
INVESTIGATION FINDINGS:
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11/18/2025 02:45 PM Licensing Program Analysts (LPAs) Rebecca Knight and Marisa Chiarelli made an unannounced visit to the facility and met with Rosanna Larsen-Burrill Business Services Director. The purpose of this visit was to deliver the results of a complaint investigation.

During the course of the investigation LPA conducted interviews and reviewed the following documents: staff list with telephone numbers, Physician’s report, Admission Agreement, needs and services plan, MAR and Resident move in record for 2 residents.

Continued on LIC9099-C
.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025
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 5
Control Number 59-AS-20251014164638
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: LASSEN HOUSE SENIOR LIVING
FACILITY NUMBER: 525002755
VISIT DATE: 11/18/2025
NARRATIVE
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Facility staff did not maintain complete and accurate residents' records. - SUBSTANTIATED

It was reported that the facility could not locate a copy of a resident’s power of attorney (POA) and social security card when requested.

LPA reviewed: Resident Move in Record for R1 which includes their social security number. Resident Move in Record for R2 does not include their social security number.

Administrator stated that POA documents for the residents have not been submitted to the facility. The facility does not have a social security card on file for R1. R1’s pre-admission paperwork does include R1’s social security number but R2’s pre-admission paperwork does not.

Per Title 22 regulations POA documents and social security cards are not required to be included in a resident’s file. However, it is a regulatory requirement that each resident shall have their social security number included in their resident file. 1 of 2 resident files reviewed does not include their social security number. This allegation is substantiated.

Based on interviews and evidence obtained during the investigation, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22), is being cited on the attached LIC9099D. Appeal rights were provided. Exit interview conducted and a copy of the report was provided to administrator Nicole Braswell.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 59-AS-20251014164638
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: LASSEN HOUSE SENIOR LIVING
FACILITY NUMBER: 525002755
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/02/2025
Section Cited
CCR
87506(b)(2)
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87506(b)(2) Resident Records (b) Each resident’s record shall contain at least the following information: (2) Social Security number. This requirement was not met as evidenced by:
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The licensee agrees to update the resident record with their social security number and will submit a copy of the document to LPA as proof of correction.
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Based on records review the facility failed to ensure that 1 of 2 resident records contain a social security number.
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POC due date 12/02/2025
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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: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
10/14/2025 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 59-AS-20251014164638

FACILITY NAME:LASSEN HOUSE SENIOR LIVINGFACILITY NUMBER:
525002755
ADMINISTRATOR:BRASWELL, NICOLEFACILITY TYPE:
740
ADDRESS:705 LUTHER RDTELEPHONE:
(530) 529-2900
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY:86CENSUS: DATE:
11/18/2025
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Rosanna Larsen-Burrill Business Services DirectorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility staff mismanaged residents’ medication. - UNSUBSTANTIATED
INVESTIGATION FINDINGS:
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11/18/2025 02:45 PM Licensing Program Analysts (LPAs) Rebecca Knight and Marisa Chiarelli made an unannounced visit to the facility and met with Rosanna Larsen-Burrill Business Services Director. The purpose of this visit was to deliver the results of a complaint investigation.

During the course of the investigation LPA conducted interviews and reviewed the following documents: staff list with telephone numbers, Physician’s report, Admission Agreement, needs and services plan, MAR and Resident move in record for 2 residents.

Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 59-AS-20251014164638
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: LASSEN HOUSE SENIOR LIVING
FACILITY NUMBER: 525002755
VISIT DATE: 11/18/2025
NARRATIVE
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Facility staff mismanaged residents’ medication. - UNSUBSTANTIATED

It was reported that staff discarded a residents Norco and Oxycodone without proper authorization.

LPA reviewed: Pharmacy medication list for R1 dated 01/06/2025 for which includes oxycodone 5 mg, order date and start date of 12/03/2024. Fax communication from the facility to R1’s doctor dated 02/17/2025 requesting to discontinue the oxycodone 5 mg for R1 at the POA’s request. R1’s physician signed the request to d/c. Medication Destruction Record for R1 dated 02/25/2025 which states that 15 5 mg oxycodone pills had been destructed and signed off by facility LVN and one other staff. There was no physician’s order for Norco on file for R1.

Administrator stated when R1 & R2 moved in they brought a bag of medications with them but they did not have a doctor’s order for oxycodone so the facility had to dispose of the medication.

It was determined there was no order for Norco on file for R1. The prescription for Oxycodone was discontinued by R1’s physician on 02/17/2025 and the facility destroyed the 15 remaining pills on 02/25/2025 which meets licensing regulation requirements. This allegation is unsubstantiated.

This agency has investigated the above allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are UNSUBSTANTIATED. No deficiency cited. Exit interview conducted and a copy of the report was provided to administrator Nicole Braswell.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5