100404809-6-17-2022-24-AS-MHON-CFSPDA-20220627111312

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 100404809
Report Date: 06/17/2022
Date Signed: 06/17/2022 01:59:15 PM

Unfounded

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
05/16/2022 and conducted by Evaluator Melinda Medina

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20220516140913

FACILITY NAME:	PALM VILLAGE RETIREMENT COMMUNITY		FACILITY NUMBER:	100404809
ADMINISTRATOR:	JIM HIGBEE		FACILITY TYPE:	741
ADDRESS:	703 WEST HERBERT AVENUE		TELEPHONE:	(559) 638-6933
CITY:	REEDLEY	STATE: CA	ZIP CODE:	93654
CAPACITY:	262	CENSUS: 162	DATE:	06/17/2022
		UNANNOUNCED	TIME BEGAN:	12:41 PM
MET WITH:	Karley Alcantar		TIME COMPLETED:	02:07 PM

ALLEGATION(S):

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9

Food Service

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) M. Medina conducted a subsequent facility visit to deliver findings. LPA identified herself and discussed the purpose of visit and the findings with Administrator, Karely Alcantar.

This Department conducted interviews, and reviewed documentation submitted during complaint investigation. This agency has investigated the complaint allegation and have found that the complaint was unfounded, therefore we have dismissed the complaint.

No deficiencies cited. Exit interview conducted

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda Medina	TELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2022

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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