107206271-9-7-2022-24-AS-SMOA-CJ4LR5-20220909085835

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107206271
Report Date: 09/07/2022
Date Signed: 09/07/2022 07:25:42 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
03/23/2022 and conducted by Evaluator Kamaldeep Kaur

COMPLAINT CONTROL NUMBER: 24-AS-20220323120146

FACILITY NAME:	AUTUMN RIDGE ASSISTED LIVING		FACILITY NUMBER:	107206271
ADMINISTRATOR:	HUNT, STEVEN		FACILITY TYPE:	740
ADDRESS:	14280 W. STANISLAUS STREET		TELEPHONE:	(559) 842-7727
CITY:	KERMAN	STATE: CA	ZIP CODE:	93630
CAPACITY:	34	CENSUS: 27	DATE:	09/07/2022
		UNANNOUNCED	TIME BEGAN:	05:35 PM
MET WITH:	Med Tech Selina Rodriguez		TIME COMPLETED:	07:30 PM

ALLEGATION(S):

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Staff are mismanaging residents medication
Staff did not prevent resident from smoking with their oxygen tank
Staff did not prevent residents from wandering away from the facility
Staff did not prevent visitors from entering the facility after hours
Staff did not prevent residents from having passcodes to enter and leave the facility
Staff left residents in soiled diapers for extended period of time.
Resident sustained diaper rashes

INVESTIGATION FINDINGS:

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The Department conducted interviews with staff and residents, reviewed resident’s records, and reviewed incontinence care checks. There have been no incidents regarding incontinence care for residents. Residents referenced in the complaints denied the allegations. The facility’s visitation policy was reviewed. Medications and MARs were reviewed. Based on interviews conducted and records reviewed, the above allegations are Unsubstantiated. Exit interview was conducted.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: See Moua	TELEPHONE: (559) 580-4596
LICENSING EVALUATOR NAME: Kamaldeep Kaur	TELEPHONE: (559) 341-7449
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022

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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