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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107201055
Report Date: 08/13/2020
Date Signed: 08/13/2020 03:46:12 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
09/30/2019 and conducted by Evaluator Lisa Salazar
COMPLAINT CONTROL NUMBER: 24-AS-20190930091052
FACILITY NAME:GARDEN TERRACE ASSISTED LIVING IIFACILITY NUMBER:
107201055
ADMINISTRATOR:HERGENROEDER, STEVE & JULIFACILITY TYPE:
740
ADDRESS:1743 E. CHENNAULTTELEPHONE:
(559) 323-1083
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:6CENSUS: 6DATE:
08/13/2020
UNANNOUNCEDTIME BEGAN:
09:21 AM
MET WITH:Julie Hergenroeder, Licensee TIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff threatens residents
Staff using inappropriate sleeping methods for residents
Facility bedroom door is in disrepair
Facility electrical is in disrepair
Facility plumbing is in disrepair
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 08/13/2020, Licensing Program Analyst (LPA), L. Salazar, contacted Licensee, Julie H to deliver findings on the above allegations. Due to COVID-19 and precautionary measures, this visit was conducted via tele inspection.

During the course of the investigation, LPA conducted record reviews, interviews with Reporting Party (RP), Licensee and Staff.Staff Interviews did not reveal that any staff has threatens residents LPA did not interview residents due to cognitive status. LPA conducted a physical tour of the facility when complaint was opened.

Record Reviews and physical plant inspection revealed Resident R1's bed was located next to the wall, not in front of door as alleged. Facility plumbing and electrical were free from obstruction and operating. LPA did not observe any cockroaches at the time of inspection. Licensee provided LPA with record of recent pest control receipts. Based on the information received, the allegations are UNFOUNDED.

Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2020
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
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
09/30/2019 and conducted by Evaluator Lisa Salazar
COMPLAINT CONTROL NUMBER: 24-AS-20190930091052

FACILITY NAME:GARDEN TERRACE ASSISTED LIVING IIFACILITY NUMBER:
107201055
ADMINISTRATOR:HERGENROEDER, STEVE & JULIFACILITY TYPE:
740
ADDRESS:1743 E. CHENNAULTTELEPHONE:
(559) 323-1083
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:6CENSUS: 6DATE:
08/13/2020
UNANNOUNCEDTIME BEGAN:
09:21 AM
MET WITH:Julie Hergenroeder, LicenseeTIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff yells at residents
Staff forced resident to take medication
Facility has cockroaches
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 08/13/2020, Licensing Program Analyst (LPA), L. Salazar, contacted Licensee, Julie H to deliver findings on the above allegations. Due to COVID-19 and precautionary measures, this visit was conducted via tele inspection.

During the course of the invesigation, LPA conducted record reviews, interviews with Reporting Party (RP), Licensee and Staff. LPA did not interview residents due to cognitive status. LPA conducted a physical tour of the facility when complaint was opened.

Staff Interviews did not reveal that staff yells or threatens residents, however, there are times when staff need to speak louder to residents that are hard of hearing. Record Reviews revealed Resident R1 is on a pureed diet and has a Dr.'s order to give medication through pureed process. Physical plant inspection did not reveal any door in disrepair. Based on the information received, the allegations are UNSUBSTANTIATED.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 2