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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107202593
Report Date: 04/07/2022
Date Signed: 04/07/2022 10:19:13 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 Lady Cabrera
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20220111100638
FACILITY NAME:EDDIE'S TERRACE #7FACILITY NUMBER:
107202593
ADMINISTRATOR:HENDRICKS, STEPHANIEFACILITY TYPE:
735
ADDRESS:1837 SOUTH BUSH AVENUETELEPHONE:
(559) 252-7811
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY:6CENSUS: 3DATE:
04/07/2022
UNANNOUNCEDTIME BEGAN:
09:54 AM
MET WITH: Joanna Castillo, Direct Support StaffTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Facility is not adhering to COVID-19 protocols
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) L. Cabrera arrived unannounced to conduct a subsequent complaint investigation at the above facility. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. Administrator Stephanie Hendricks was unavailable and Administrator Maricia Alvarado approved for Joanna Castillo to sign this report.

Upon entry to the facility, LPA observed a sign-in policy being implemented for all visitors. Facility staff and visitors are screened prior to entry and will wear face masks.

During this visit LPA delivered investigation findings regarding the above allegation. The Department has investigated the complaint alleging: Facility is not adhering to COVID-19 protocols. During the investigation, the Department conducted interviews, toured the facility via video on 01/13/2022, and reviewed records. During the 01/13/2022 video tour, LPA observed enough PPE supplies, cleaning and PPE supplies. Hand washing posters were observed by the kitchen and bathroom sink.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Lady Cabrera
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022
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-20220111100638
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 #7
FACILITY NUMBER: 107202593
VISIT DATE: 04/07/2022
NARRATIVE
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LPA observed staff wearing N95 masks. Staff reported Covid-19 positive resident’s will self-isolate in room. Staff will clean and disinfect the facility throughout their shift. Per records and interviews, Staff that were positive for Covid-19 were self-isolating at home. Based on the interviews conducted and records review the above allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.


LPA provided staff with a copy of this report.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Lady Cabrera
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2