100400544-4-15-2021-24-AS-MHON-C4YM88-20210716092239

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 100400544
Report Date: 01/13/2021
Date Signed: 04/15/2021 02:08:54 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
05/19/2020 and conducted by Evaluator Alexandria Walton

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20200519135933

FACILITY NAME:	TERRACES AT SAN JOAQUIN GARDENS, THE		FACILITY NUMBER:	100400544
ADMINISTRATOR:	LOPEZ, JESSICA		FACILITY TYPE:	741
ADDRESS:	5555 NORTH FRESNO STREET		TELEPHONE:	(559) 439-4770
CITY:	FRESNO	STATE: CA	ZIP CODE:	93710
CAPACITY:	652	CENSUS:	DATE:	01/13/2021
		UNANNOUNCED	TIME BEGAN:	11:06 AM
MET WITH:	Executive Director, Shaun Rushforth		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Resident was found on floor for extended period of time

INVESTIGATION FINDINGS:

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The following is an amended report.

On 4/15/2021 Licensing Program Analyst (LPA) A. Walton contacted Executive Director (ED), Shaun Rushforth to deliver findings on the above allegation via telephone due to COVID-19 and precautionary measures. LPA introduced self and discussed the purpose of the call with the ED.

During the course of the investigation, LPA conducted interviews and reviewed records.

Review of resident records revealed, R1 resided in an independent living apartment at the above facility and did not require assistance with showering or toileting. Residents at the facility, were asked to push a button each morning that would notify staff that they are okay. If facility staff did not hear from a resident by a specific time each day, the facility would conduct a wellness check.

Continued to LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria Walton	TELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2021

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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Control Number 24-AS-20200519135933

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: TERRACES AT SAN JOAQUIN GARDENS, THE	FACILITY NUMBER: 100400544
	VISIT DATE: 01/13/2021

NARRATIVE

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Staff interviews revealed that, during the period of 5/13/2020 through 5/16/2020, facility staff conducted wellness checks each day for R1 when R1 did not push the button to notify staff that R1 was okay. Facility staff knocked on R1’s door and when R1 did not respond, facility staff entered R1’s apartment. On each day of the wellness checks, facility staff reported that R1 was in the bathroom and reported being okay.

On 5/16/2020 at approximately 7:30PM, R1’s family contacted the facility to request a wellness check as family was unable to reach R1. At this time, S1 found R1 lying on the bathroom floor, unclothed and in urine. S1 observed bruising to R1’s back and lower buttocks and 911 was called. Per resident records, R1 reported walking the previous day.

Based on interviews conducted with staff and review of records, it could not be determined how long R1 was on the floor. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation: R1 was on the floor for an extended period of time is UNSUBSTANTIATED.

No deficiencies issued during this inspection.

An exit interview was conducted with ED. A copy of this report was discussed and provided to ED via email and an electronic read receipt confirms receiving this document. Facility representative signature on file.

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria Walton	TELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2021

LIC9099 (FAS) - (06/04)

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Control Number 24-AS-20200519135933

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: TERRACES AT SAN JOAQUIN GARDENS, THE	FACILITY NUMBER: 100400544
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/13/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/14/2021 Section Cited CCR 87468.2(a)(4)	1 2 3 4 5 6 7	Dismissed	1 2 3 4 5 6 7	Dismissed.
	8 9 10 11 12 13 14		8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria Walton	TELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2021

LIC9099 (FAS) - (06/04)

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