100400622-10-20-2023-24-AS-SMOA-CWSRPD-20231020131147

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 100400622
Report Date: 09/22/2023
Date Signed: 10/20/2023 12:20:41 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
08/22/2023 and conducted by Evaluator Kelly J. McClurg

COMPLAINT CONTROL NUMBER: 24-AS-20230822160113

FACILITY NAME:	TWILIGHT HAVEN		FACILITY NUMBER:	100400622
ADMINISTRATOR:	LONG, TERESA		FACILITY TYPE:	740
ADDRESS:	1717 SOUTH WINERY AVENUE		TELEPHONE:	(559) 251-8417
CITY:	FRESNO	STATE: CA	ZIP CODE:	93727
CAPACITY:	116	CENSUS: 30	DATE:	09/22/2023
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	RCFE Operations Manager (OM) Kristine Williams & Program Director (PD) Phylicia Smith		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Licensee does not ensure the facility is in good repair.
Staff did not assist resident with a dressing change
Staff threatened resident and did not treat resident with dignity or respect

INVESTIGATION FINDINGS:

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An unannounced Complaint visit was conducted on the date & time indicated above by Licensing Program Analyst (LPA) K. Mcclurg. LPA met with RCFE Operations Manager (OM) Kristine Williams & Program Director (PD) Phylicia Smith, & stated purpose of visit.

Allegations reviewed with OM & PD. Facility toured. Resident rooms toured. Rooms appeared & smelled to be clean. Rooms were not observed to be dusty &/or dirty. Floors, walls, ceilings observed to be devoid of debris, significant dirt, or cobwebs. Hot water & AC operational.
Incident review regarding dressing change. Care Givers are not allowed to change dressings, only MedTechs. No indication that a MedTech did not change the dressing.
No evidence or knowledge of staff threatening or being overtly disrespectful to resident.

The Department has investigated the above allegations & determined them to be Unsubstantiated.

Exit review done with OM. Report provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: See Moua	TELEPHONE: (559) 580-4596
LICENSING EVALUATOR NAME: Kelly J. McClurg	TELEPHONE: (559) 246-0435
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023

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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