Senior Care Records.

Complaint Investigation Report

Three Pines Adult Residential Facility, Auburn11/03/2021Licence 317001368

Census5
Date signed11/03/2021 02:53:35 PM
The inspector’s account

317001368-11-3-2021-27-AS-TORZ-C9HVYT-20211208155141

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 520 COHASSET RD., STE. 170

This is an official report of an unannounced visit/investigation of a complaint received in our office on

01/04/2021 and conducted by Evaluator Todd Tryon

COMPLAINT CONTROL NUMBER: 27-AS-20210104114658

Arrived at the facility to complete the complaint. LPA met with Administrator Chris Chu. LPA had contacted the facility and screened to learn that there are no current COVID cases in the facility. LPA checked my own temperature, wore a surgical mask, and used hand sanitizer prior to the visit.

LPA has spoken with witnesses, staff, residents, reviewed records. Through interview LPA learned that prior to the COVID epidemic, the staff was leaving the morning dose of medication for resident R1 in an unlocked drawer in the kitchen so that she could take her own medication early in the morning when she was leaving early for her day program. Even though all the other medications in the house may have been secured in the office, there were a few pills unlocked in the drawer, that anyone could have potentially accessed. Therefore, the allegation that medications were not locked is SUBSTANTITATED. A finding of substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiency is cited as per Title 22 regulations. Exit interview conducted, appeal rights given to staff.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction