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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107206335
Report Date: 07/09/2024
Date Signed: 08/05/2024 04:22:17 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
02/12/2024 and conducted by Evaluator Kelly J. McClurg
COMPLAINT CONTROL NUMBER: 24-AS-20240212150254
FACILITY NAME:ROYAL BOARD AND CARE FOR ELDERLYFACILITY NUMBER:
107206335
ADMINISTRATOR:RIGON, RUDYFACILITY TYPE:
740
ADDRESS:3407 N. FRESNOTELEPHONE:
(559) 903-6846
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY:6CENSUS: DATE:
07/09/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee/Administrator (L/A) Rudy Rigon & Assistant Administrator (AA) Aurora RigonTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff did not ensure to seek medical attention to resident in a timely manner.
INVESTIGATION FINDINGS:
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A Complaint investigation was conducted by Licensing Program Analyst (LPA) K. McClurg. LPA met with Licensee/Administrator (L/A) Rudy Rigon & Assistant Administrator (AA) Aurora Rigon. LPA greeted L/A & AA, stated purpose of visit & was allowed to proceed with visit.

LPA & AA reviewed allegations & information in connection with. According to AA staff frequently contact 911 when resident requests, or it is determined that resident may require medical attention. Residents attend physician appointments as determined by physician's availability.

The Department has investigated the above allegation & found it be Unsubstantianed.

Exit interview conducted with Assistant Administrator (AA) Aurora Rigon.
Report provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) 580-4596
LICENSING EVALUATOR NAME: Kelly J. McClurgTELEPHONE: (559) 246-0435
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
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 3
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
02/12/2024 and conducted by Evaluator Kelly J. McClurg
COMPLAINT CONTROL NUMBER: 24-AS-20240212150254

FACILITY NAME:ROYAL BOARD AND CARE FOR ELDERLYFACILITY NUMBER:
107206335
ADMINISTRATOR:RIGON, RUDYFACILITY TYPE:
740
ADDRESS:3407 N. FRESNOTELEPHONE:
(559) 903-6846
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY:6CENSUS: DATE:
07/09/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee/Administrator (L/A) Rudy Rigon & Assistant Administrator (AA) Aurora RigonTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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2
3
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5
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7
8
9
Staff did not report an incident involving resident while in care.
INVESTIGATION FINDINGS:
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Through conversation with AA & review of reports submitted to the Department it was determined that Incident Reports have not been submitted to the Department regularly.

The Department has investigated the above allegation & determined it to be Substantiated.

Deficiency issued.

Exit interview conducted with AA. Copy of report provided.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) 580-4596
LICENSING EVALUATOR NAME: Kelly J. McClurgTELEPHONE: (559) 246-0435
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 24-AS-20240212150254
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: ROYAL BOARD AND CARE FOR ELDERLY
FACILITY NUMBER: 107206335
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/12/2024
Section Cited
CCR
87211
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Reporting Requirements
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AA agreed to submit letter to the Department that L/A & AA & have read section 87211 & agree to meet all regulations regarding Reporting Requirments. To be submitted by due date.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) 580-4596
LICENSING EVALUATOR NAME: Kelly J. McClurgTELEPHONE: (559) 246-0435
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3