100400070-5-17-2022-24-AS-SMOA-CF6U9W-20220607152348

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 100400070
Report Date: 05/17/2022
Date Signed: 05/17/2022 03:22:42 PM

Unsubstantiated

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
03/21/2022 and conducted by Evaluator Kamaldeep Kaur

COMPLAINT CONTROL NUMBER: 24-AS-20220321142901

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:	368	CENSUS: 205	DATE:	05/17/2022
		UNANNOUNCED	TIME BEGAN:	02:48 PM
MET WITH:	Administrator Paul Rocha		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Resident had multiple falls and sustained injuries while in care
Staff failed to seek medical attention for resident in a timely manner

INVESTIGATION FINDINGS:

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The Department interviewed staff, resident, and reviewed records. In the case of: Resident had multiple falls and sustained injuries while in care based on interviews conducted, although resident did sustain falls, the Facility did due diligence in following required protocol. Facility RN conducted a Neuro assessment after the falls and the resident was placed on 30 min checks for 72 hours. Incident report was submitted to the Department regarding falls.

In the case of Staff failed to seek medical attention for resident in a timely manner. 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 allegations are UNSUBSTANTIATED.

Exit interview was conducted.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda White	TELEPHONE: (550) 243-8080
LICENSING EVALUATOR NAME: Kamaldeep Kaur	TELEPHONE: (559) 341-7449
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2022

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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