107201156-10-17-2022-24-AS-MHON-CKLLJ9-20221027084735

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107201156
Report Date: 10/17/2022
Date Signed: 10/17/2022 07:42:45 PM

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
06/13/2022 and conducted by Evaluator Malia Thao

COMPLAINT CONTROL NUMBER: 24-AS-20220613105348

FACILITY NAME:	FAIRWINDS - WOODWARD PARK		FACILITY NUMBER:	107201156
ADMINISTRATOR:	VALERO, DESIREE		FACILITY TYPE:	740
ADDRESS:	9525 N FT WASHINGTON RD		TELEPHONE:	(559) 434-6444
CITY:	FRESNO	STATE: CA	ZIP CODE:	93730
CAPACITY:	270	CENSUS: 212	DATE:	10/17/2022
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Desiree Valero, Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff mishandled a resident's medication while in care resulting in resident's hospitalization.

INVESTIGATION FINDINGS:

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On 10/17/22 at 11:15 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to deliver the findings. LPA explained the reason for inspection and met with Administrator Desiree Valero.

LPA reviewed records and conducted interviews. Based on review of records, the allegation that staff mishandled a resident's medication resulted in the resident's hospitalization is unsubstantiated. Review of records show that upon admission to the hospital, R1's vitals were stable. No documentation was observed to indicate that R1's admission to the hospital or eventual diagnosis was related to medication mishandling. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Exit interview conducted. A copy of this report was given to Administrator Desiree Valero, whose signature confirms receipt of this report.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Malia Thao	TELEPHONE: (559) 470-9001
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2022

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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