100400070-1-4-2021-24-AS-AXIG-BWZQR4-20210106112316

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 100400070
Report Date: 01/04/2021
Date Signed: 01/04/2021 11:28:58 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/05/2020 and conducted by Evaluator See Moua

COMPLAINT CONTROL NUMBER: 24-AS-20201005154102

FACILITY NAME:	CALIFORNIA ARMENIAN HOME		FACILITY NUMBER:	100400070
ADMINISTRATOR:	PAUL ROCHA		FACILITY TYPE:	741
ADDRESS:	6720 E KINGS CANYON RD		TELEPHONE:	(559) 251-8414
CITY:	FRESNO	STATE: CA	ZIP CODE:	93727
CAPACITY:	332	CENSUS: 138	DATE:	01/04/2021
		UNANNOUNCED	TIME BEGAN:	11:14 AM
MET WITH:	Paul Rocha, Administrator		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Staff are mismanaging resident's medications
Staff do not adequately log medications
Staff are not adequately trained

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) S. Moua called and spoke with Administrator Paul Rocha regarding the complaint allegations. Findings were delivered over the phone due to COVID 19 precaution guidelines.

Facility staff and residents referenced in the complaint were interviewed. There was no confirmation that medication errors were made or that residents’ medications were mismanaged. Records reviewed and observations conducted support that medications appear to be given as prescribed. Staff training records and In-Service training documentation were also reviewed and staff met the required initial and yearly training. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is Unsubstantiated. Exit Interview was conducted.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Andy Xiong	TELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: See Moua	TELEPHONE: (559) 650-7904
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2021

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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