525002810-1-19-2024-59-AS-KHOS-D26V6V-20240205151011

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 525002810
Report Date: 01/19/2024
Date Signed: 01/19/2024 01:22:03 PM

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
11/29/2023 and conducted by Evaluator Jaynae Boyles

COMPLAINT CONTROL NUMBER: 59-AS-20231129092136

FACILITY NAME:	TREASURE		FACILITY NUMBER:	525002810
ADMINISTRATOR:	LEAK, TAMRA		FACILITY TYPE:	740
ADDRESS:	25353 LEE ST		TELEPHONE:	(530) 604-2602
CITY:	LOS MOLINOS	STATE: CA	ZIP CODE:	96055
CAPACITY:	6	CENSUS: 6	DATE:	01/19/2024
		UNANNOUNCED	TIME BEGAN:	01:11 PM
MET WITH:	Assistant Administrator- Ana Virgenr.		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff did not follow the resident’s care plan.
Staff did not allow a resident to go on an outing.
Staff did not seek medical attention for a resident in care.
Staff spoke to residents in an inappropriate manner.
Staff left residents in a soiled diaper for a long period of time.

INVESTIGATION FINDINGS:

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01/19/2024 Licensing Program Analyst (LPA) Jaynae Boyles made an unannounced visit to the facility and met with Assistant Administrator, Ana Virgen. The purpose of this visit is to deliver the results of a complaint investigation.

During the interview process, the Administrator, five staff members and one resident (R1) were interviewed. During the review of records, LPA reviewed the files of two residents, including Incident reports, Medical Records, and Individual Program Plan.

Continued on LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Jaynae Boyles
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20231129092136

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: TREASURE	FACILITY NUMBER: 525002810
	VISIT DATE: 01/19/2024

NARRATIVE

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LPA investigated the allegation, “Staff did not follow resident's care plan.” The Administrator reported that all care plans are created collaboratively with staff and adjusted when there is a change in condition for the residents in care. LPA observed 2 resident files which had current Individual Program Plans in the file.

LPA investigated the allegation, “Staff did not allow a resident to go on an outing.” During the investigation, it was reported by all staff persons that all residents have the opportunity to attend regular scheduled outings and if these outing are missed they are rescheduled for the resident.

LPA investigated the allegation, “Staff did not seek medical attention for a resident in care.” During the investigation, it was reported by all staff persons the protocol for when residents fall or when there is a change in condition for a resident. All staff appeared to be well versed in the policy and procedures for ensuring timely medical care for residents.

LPA investigated the allegation, “Staff spoke to resident in an inappropriate manner.” During the investigation, it was reported by all staff persons that no staff members use inappropriate language toward residents in care or have they observed staff members speaking inappropriately toward residents in care. R1 stated that no staff member has ever spoken inappropriately towards her or any other residents.

LPA investigated the allegation, “Staff left resident in a soiled diaper for a long period of time”. During the investigation, it was reported by all staff persons that residents with incontinence are checked hourly. The administrator reported that there are more staff at this facility to ensure that residents with incontinence have more attention to ensure that they are changed frequently.

This agency has investigated the complaint alleging “Staff did not follow resident's care plan, Staff did not allow a resident to go on an outing, Staff did not seek medical attention for a resident in care, Staff spoke to resident in an inappropriate manner, Staff left resident in a soiled diaper for a long period of time”. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are UNSUBSTANTIATED.

An exit interview was conducted. A copy of the report was provided to the assistant administrator, Ana Virgen.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Jaynae Boyles
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2024

LIC9099 (FAS) - (06/04)

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