100408901-10-22-2020-24-AS-AXIG-BUWMFS-20201031093448

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 100408901
Report Date: 10/14/2020
Date Signed: 10/22/2020 01:17:42 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
09/03/2020 and conducted by Evaluator See Moua

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20200903093448

FACILITY NAME:	GARDEN MANOR		FACILITY NUMBER:	100408901
ADMINISTRATOR:	BLACK, JOAN		FACILITY TYPE:	740
ADDRESS:	4983 E. OLIVE		TELEPHONE:	(559) 255-8650
CITY:	FRESNO	STATE: CA	ZIP CODE:	93727
CAPACITY:	49	CENSUS: 47	DATE:	10/14/2020
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Joan Black, Administrator		TIME COMPLETED:	11:31 AM

ALLEGATION(S):

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Staff are not answering facility phone
Staff took residents phone away

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) S. Moua contacted the facility via telephone to conduct a subsequent complaint inspection due to COVID-19 precautionary measures. LPA discussed the specific allegations with the Administrator. Findings were delivered.

LPA interviewed staff and residents at the facility. Staff denied that the facility does not answer its phone or that resident’s phones were taken away. Residents at the facility were also interviewed and confirmed that they have access to a telephone, get their messages, and can use the phone anytime. LPA called the facility and observed a working telephone. Staff picked and LPA was able to speak to residents. Based on interviews conducted and observed, the allegations are Unfounded. Exit Interview was conducted. No deficiencies were observed.

Unfounded

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: 10/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2020

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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