100400622-9-22-2020-24-AS-AXIG-BTVUZX-20200928160214

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 100400622
Report Date: 09/21/2020
Date Signed: 09/22/2020 09:42:59 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
07/28/2020 and conducted by Evaluator See Moua

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20200728134301

FACILITY NAME:	TWILIGHT HAVEN		FACILITY NUMBER:	100400622
ADMINISTRATOR:	RAMIREZ, SYLVIA		FACILITY TYPE:	740
ADDRESS:	1717 SOUTH WINERY AVENUE		TELEPHONE:	(559) 251-8417
CITY:	FRESNO	STATE: CA	ZIP CODE:	93727
CAPACITY:	116	CENSUS: 40	DATE:	09/21/2020
		UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Sylvia Ramirez, Administrator		TIME COMPLETED:	11:21 AM

ALLEGATION(S):

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Residents rooms are not properly maintained

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) S. Moua conducted a subsequent complaint inspection over the phone with Administrator Sylvia Ramirez due to COVID-19 precautionary measures. Allegation was reviewed and finding was delivered.

LPA interviewed staff and residents regarding cleaning of residents' rooms. Facility staff denied that resident's rooms are not properly maintained and stated that rooms were cleaned once a week as per agreement. Due to COVID, facility has implemented additional cleaning throughout the week. LPA, along with Program Clinical Consultant conducted a Televisit and toured the facility and resident's room. Facility and rooms were observed to be properly maintained. There is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is Unsubstantiated. No deficiency was observed. Exit Interview was conducted.

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: 09/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2020

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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