100404809-6-19-2023-24-AS-SMOA-CT2LNE-20230622085409

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 100404809
Report Date: 06/14/2023
Date Signed: 06/19/2023 10:22:27 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 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
05/26/2023 and conducted by Evaluator Mai Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20230526144209

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: 163	DATE:	06/14/2023
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Karely Alcantar, Administrator		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Facility alarms do not work properly
Facility failed to properly serve food

INVESTIGATION FINDINGS:

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On 06/14/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to deliver findings on the
above allegations. LPA introduced self, stated the purpose of the visit, and met with Administrator Karely Alcantar.

During the course of the investigation, LPA conducted interviews, toured the facility, and reviewed records. LPA observed during the tour, Memory Care alarm door secure and opens with entry code and courtyard alarm was operating properly. Food temperature were documented prior to food being served for each meal.Food was observed inside food cart covered with tray cover.

Based on observation, records reviewed, and interviews which were conducted, the preponderance of evidence standard has not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. Exit interview conducted. A copy of this report was provided to the Administrator.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: See Moua	TELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai Yang	TELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023

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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