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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107200907
Report Date: 03/09/2022
Date Signed: 03/09/2022 11:43:02 AM

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
01/11/2022 and conducted by Evaluator Alexandria Walton
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20220111112514
FACILITY NAME:EDDIE'S TERRACEFACILITY NUMBER:
107200907
ADMINISTRATOR:HENDRICKS, STEPHANIEFACILITY TYPE:
735
ADDRESS:2693 SOUTH BARDELL AVENUETELEPHONE:
(559) 485-4911
CITY:FRESNOSTATE: CAZIP CODE:
93706
CAPACITY:6CENSUS: 3DATE:
03/09/2022
UNANNOUNCEDTIME BEGAN:
09:07 AM
MET WITH:Caregiver, Kenisha DunhamTIME COMPLETED:
10:08 AM
ALLEGATION(S):
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Facility is not adhering to COVID protocols
INVESTIGATION FINDINGS:
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On 03/09/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct a subsequent complaint investigation at the above faciilty. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. The Administrator was not present in the facility, facility staff Kenisha Dunham contacted Administrator via phone. LPA spoke with Administrator and received verbal permission to meet with facility staff, Kenisha.

Today's inspection included a facility tour and staff interviews.

Upon entry to the facility, LPA observed a sign-in policy being implemented for all visitors. Facility staff are screened prior to entry, ensure facial coverings are worn correctly and will clean and sanitize hands after entering the facility and prior to starting a shift.
CONTINUED TO 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 24-AS-20220111112514
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: EDDIE'S TERRACE
FACILITY NUMBER: 107200907
VISIT DATE: 03/09/2022
NARRATIVE
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Interviews with staff revealed that if a resident tests positive for COVID-19, the resident will isolate in the resident's private room and will be asked to wear a facial covering if entering the common areas of the facility. The facility staff will wear full PPE when a facility resident is COVID-19 positive.

Facility staff have been informed to stay home if there are any signs of a respiratory illness. Staff are not able to return to work unless a copy of a negative test result is received.

During the facility tour, LPA observed signs promoting social distancing, cough/sneeze etiquette, and hand washing. LPA observed facility staff to be properly wearing facial coverings. 3 out of 3 residents are present. Residents observed to be participating in activities and were physically distanced.

Based on observation, interviews, and records review, the allegation: Facility is not adhering to COVID protocols, is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

No deficiencies issued.

An exit interview was conducted with Facility staff and Administrator, Marcia Alvarado. A copy of this report will be provided via email due to COVID-19 precautionary measures. Report signed on-site by Facility Representative.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022
LIC9099 (FAS) - (06/04)
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