100400544-6-18-2021-24-AS-SPIY-C4NT26-20210706142013

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 100400544
Report Date: 06/18/2021
Date Signed: 06/18/2021 03:18:15 PM

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
05/05/2021 and conducted by Evaluator Lady Cabrera

COMPLAINT CONTROL NUMBER: 24-AS-20210505110512

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: 301	DATE:	06/18/2021
		UNANNOUNCED	TIME BEGAN:	12:54 PM
MET WITH:	Valerie Epps, Designated Representative		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Resident sustained a fall while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Lady Cabrera the subsequent complaint visit. LPA spoke with Designated Representative Valerie Epps and delivered investigation findings regarding the above allegation. Administrator Shaun Rushforth was unavailable.

The Department conducted interviews with staff and records reviewed. Resident (R1) had a history of falls while in the Memory Care Unit. R1 sustained falls while in care and was provided immediate assessment and/or assistance by the facility staff. R1 was sent to the hospital due to change of condition. Facility continued to monitor R1, conducted frequently safety checks due to R1 was at risk for falls, follow-up with medications, and monitor changes of condition. We have found that the complaint was Unfounded, therefore we have dismissed the complaint.

Exit interview was conducted. Designated Representative was informed that as a COVID-19 precautionary measure, this report will be emailed.

Unfounded

Estimated Days of Completion: 60

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Lady Cabrera	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2021

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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