525002810-1-28-2025-59-AS-LCRR-DDJQ96-20250203105750

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 525002810
Report Date: 01/28/2025
Date Signed: 01/28/2025 09:34:19 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
12/11/2024 and conducted by Evaluator Rebecca Knight

COMPLAINT CONTROL NUMBER: 59-AS-20241211085810

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:	DATE:	01/28/2025
		UNANNOUNCED	TIME BEGAN:	09:18 AM
MET WITH:	Anna Castillo-Virgen		TIME COMPLETED:	09:45 AM

ALLEGATION(S):

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Staff did not provide adequate supervision to resident in care resulting in injuries.- UNSUBSTANTIATED
Staff leave residents sitting on their wheelchair for an extended period of time.- UNSUBSTANTIATED

INVESTIGATION FINDINGS:

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01/28/2025 09:18 AM Licensing Program Analyst (LPAs) Rebecca Knight and Kayla Adkison, made an unannounced visit to the facility and met with administrator Anna Castillo-Virgen. 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: Admission agreement, IPP, Needs & Services plan, LIC600 Physicians Report, Care Plan, care notes, physical therapy evaluation, related incident reports, communication log for 1 resident, staff list with telephone numbers.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025

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-20241211085810

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: 01/28/2025

NARRATIVE

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Staff did not provide adequate supervision to resident in care resulting in injuries. - UNSUBSTANTIATED

It was alleged that there is a resident in the home that requires 24/7 assistance, is fall risk. Alleges this resident falls daily and has been wounded as a result of the falls. Alleges the company has not looked further into placing the resident in another home where they can get the proper assistance they require.

On 11/20/2024 R1 was evaluated by a physical therapist (PT) from Butte Home Health & Hospice. The PT determined R1 was not a candidate for skilled Physical Therapy intervention due to their inability to follow instructions or learn techniques for improved balance. For this reason, the PT provided their professional opinion that the best solution for preventing R1 from future falls and possible hospitalization is for the arrangement and funding for a one-on-one caregiver situation.

The licensee provided a detailed outline of communications with Far Northern Regional Center (FNRC) concerning the need for intensive staffing for R1 or the need to transfer R1 to a higher level of care. This communication started on 08/22/2024. On 09/23/2024 the licensee met with FNRC and a supervisor agreed that R1 should have intensive staffing which should be 24 hours a day. On 10/23/2024 licensee took R1 to a medical appointment for gait training. 11/14/2024 Zoom meeting held with FNRC and licensees regarding intensive staffing request for R1.

Licensee submitted the following incidents reporting falls for R1 on the dates of 08/09/2024, 10/03/2024 R1 fell and was transported to the ER for evaluation, no injuries were sustained, first aid provided. On 11/03/2024, and 11/26/2024 R1 fell, did not sustain significant injuries, was provided first aid at the facility.

Staff interviews revealed that R1 has had falls but has not been injured as a result, has sustained some cuts and bruises. Staff provided first aid to R1. Staff stated that R1 started 1:1 (intensive staffing) in December 2024 after the facility received approval from FNRC.

It was determined that starting in August 2024 the facility had been working with FNRC to obtain intensive staffing for R1 due to increase in falls. Intensive staffing for R1 started in December 2024 and R1 has not sustained any falls since. The licensee showed due diligence in obtaining required services for R1. This allegation is unsubstantiated.

Continued on LIC9099-C

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20241211085810

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: 01/28/2025

NARRATIVE

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Staff leave residents sitting on their wheelchair for an extended period of time - UNSUBSTANTIATED

It was alleged that staff let the residents sit at the dinner table for long periods of time in their wheelchairs rather than taking them to the restroom or back to bed.

All staff interviewed stated that residents are encouraged to sit up for ten to twenty minutes after they have a meal to encourage good digestion. The residents stay at the table and socialize or watch TV together.

It was determined that ten or twenty minutes is not an extended period of time for a resident to sit in a wheelchair after a meal. This allegation is unsubstantiated.

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.

No deficiencies cited. Exit interview conducted and a copy of the report was provided to administrator Anna Castillo-Virgen and licensee Tamra Leak.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025

LIC9099 (FAS) - (06/04)

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