107201055-11-19-2021-24-AS-MHON-C9AVYZ-20211201155155

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107201055
Report Date: 11/19/2021
Date Signed: 11/19/2021 01:49:00 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
09/07/2021 and conducted by Evaluator Alexandria Walton

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20210907130401

FACILITY NAME:	GARDEN TERRACE ASSISTED LIVING II		FACILITY NUMBER:	107201055
ADMINISTRATOR:	HERGENROEDER, STEVE & JULI		FACILITY TYPE:	740
ADDRESS:	1743 E. CHENNAULT		TELEPHONE:	(559) 323-1083
CITY:	FRESNO	STATE: CA	ZIP CODE:	93720
CAPACITY:	6	CENSUS: 6	DATE:	11/19/2021
		UNANNOUNCED	TIME BEGAN:	12:28 PM
MET WITH:	Caregiver, Cynthia Minor		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Lack of supervision resulting in resident wandering away from facility
Staff handled resident in a rough manner

INVESTIGATION FINDINGS:

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On 11/19/2021, Licensing Program Analyst (LPA) A. Walton arrived unannounced to deliver findings on the above allegation. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. Administrator is not available to meet. LPA met with Caregiver, Cynthia Minor.

During the course of the investigation, LPA reviewed records and interview staff.

Based on interviews conducted, the allegations: Lack of supervision resulting in resident wandering away from facility and Staff handled resident in a rough manner are UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

No deficiencies issued during this inspection.

An exit interview was conducted. As a COVID-19 precautionary measure, a copy of this report will be provided via email and an electronic read receipt confirms receiving this document. Report signed on-site by Facility Representative.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria Walton	TELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021

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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