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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107201295
Report Date: 08/28/2023
Date Signed: 08/28/2023 08:12:40 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
08/18/2023 and conducted by Evaluator Kelly J. McClurg
COMPLAINT CONTROL NUMBER: 24-AS-20230818161051
FACILITY NAME:MARTIN'S HOME-HOMSYFACILITY NUMBER:
107201295
ADMINISTRATOR:MARTIN, WILMAFACILITY TYPE:
735
ADDRESS:345 NORTH HOMSY AVENUETELEPHONE:
(559) 412-8903
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY:6CENSUS: 2DATE:
08/28/2023
UNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Licensee (L) Wilma Martin & Caregiver (CG) Neil Martin (husband to L.)TIME COMPLETED:
08:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Drug activity on the premises
Staff did not provide a safe and comfortable environment for residents

INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
An unannounced Complaint visit was conducted on the date & tines indicated above by Licensing Program Analyst (LPA) K. McClurg. LPA met with Licensee (L) Wilma Martin & Caregiver (CG) Neil Martin (husband to L.). Allegations reviewed with L & CG.
Facility toured. Client rooms, bathrooms, common areas appeared to be clean. No excess debris or unpleasant odors detected in home. Inside temperature felt cool & comfortable. Pool observed to be appropriately fenced with pool gate locked. Did not observe indication(s) to suggest drug activity on the premises. Clients observed to be clean & well groomed.

The Department has investigated the above allegations & determined them to be Unsubstantiated.

Exit interview conducted with L & CG. Copy of report provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023
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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