100400544-10-12-2021-24-AS-SPIY-C7SSGN-20211014135214

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 100400544
Report Date: 10/12/2021
Date Signed: 10/12/2021 09:52:37 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
09/16/2021 and conducted by Evaluator Lady Cabrera

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20210916112628

FACILITY NAME:	TERRACES AT SAN JOAQUIN GARDENS, THE		FACILITY NUMBER:	100400544
ADMINISTRATOR:	SHAUN RUSHFORTH		FACILITY TYPE:	741
ADDRESS:	5555 NORTH FRESNO STREET		TELEPHONE:	(559) 439-4770
CITY:	FRESNO	STATE: CA	ZIP CODE:	93710
CAPACITY:	652	CENSUS: 359	DATE:	10/12/2021
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Shaun Rushforth, Administrator		TIME COMPLETED:	09:52 AM

ALLEGATION(S):

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Resident had an unwitnessed fall sustaining a fracture.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Lady Cabrera the subsequent complaint visit. LPA met with Shaun Rushforth and delivered investigation findings regarding the above allegation.

The Department conducted interviews with staff and records reviewed. Per records reviewed, Resident (R1) was a at risk for falls in the Memory Care Unit. The facility implemented a Care Plan, which indicates the interventions staff would use in order to minimize R1’s fall risk. On 09/12/2021, R1 sustained a fall and injury. R1 was hospitalized after the fall, but it was not found the fall occurred due to any neglect of facility staff. Based on interviews and records, R1 was provided immediate evaluation and assistance by the facility staff. R1 was sent to the hospital due to change of condition. We have found that the complaint was Unfounded, therefore we have dismissed the complaint.

Exit interview was conducted. Administrator was provided with a copy of this report.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Lady Cabrera	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

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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