100400070-4-7-2021-24-AS-AXIG-C2BLBF-20210422083640

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 100400070
Report Date: 04/06/2021
Date Signed: 04/07/2021 10:47:29 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
02/12/2021 and conducted by Evaluator See Moua

COMPLAINT CONTROL NUMBER: 24-AS-20210212143429

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: 174	DATE:	04/06/2021
		UNANNOUNCED	TIME BEGAN:	09:24 AM
MET WITH:	Paul Rocha, Administrator		TIME COMPLETED:	09:25 AM

ALLEGATION(S):

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Facility overcharged resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) S. Moua conducted a subsequent complaint inspection via telephone due to COVID-19 precautionary measures. LPA spoke with Administrator Paul Rocha, discussed the allegation, and delivered the findings.

The Department conducted interviews and reviewed records. The overcharged fee referenced in the complaint pertains to the facility's unit to unit transfer fee, when requested by a resident or his/her responsible party. The fee is outlined in the Admission Agreement. R1's responsible party denied being informed of this fee when R1 was moved into a different unit. Facility staff stated R1's responsible party was informed of the fee. R1's responsible party did not pay the fee and facility will not pursue payment. Based on interviews conducted and records reviewed, the allegation is Unsubstantiated.

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: 04/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2021

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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