107206609-1-19-2023-24-AS-SPIY-CN9LWK-20230120080715

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107206609
Report Date: 01/19/2023
Date Signed: 01/19/2023 10:36:48 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
09/12/2022 and conducted by Evaluator Darius Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20220912095232

FACILITY NAME:	GETTYSBURG CHRISTIAN HOME		FACILITY NUMBER:	107206609
ADMINISTRATOR:	DYER, ELIZABETH		FACILITY TYPE:	740
ADDRESS:	4844 E. GETTYSBURG		TELEPHONE:	(559) 294-9080
CITY:	FRESNO	STATE: CA	ZIP CODE:	93726
CAPACITY:	18	CENSUS: 13	DATE:	01/19/2023
		UNANNOUNCED	TIME BEGAN:	08:34 AM
MET WITH:	Staff, Joyce Torres		TIME COMPLETED:	09:08 AM

ALLEGATION(S):

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Staff engaged in a physical altercation with resident in care resulting in resident sustaining injuries.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Darius Williams conducted an unannounced follow up visit. LPA Williams met with Staff Joyce Torres and discussed the purpose of the visit. LPA Williams spoke with the Administrator via phone and disccused the purpose of the visit.

In regards to the allegation, staff engaged in a physical altercation with resident in care resulting in resident sustaining injuries, on a date near the end of August 2022, Witness 1 (W1) observed bruises on Resident 1 (R1) which was attributed to a fall. On 9/5/2022, the Administrator contacted Emergency Services (EMS) as R1 was becoming combative. W1 arrived to the facility as EMS arrived and reported no new marks were observed on R1. On 9/6/2022, Witness 3 observed scratch marks on the forearms of the Administrator.

*Continued on LIC 9099C*

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Serigy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius Williams	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023

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 4

Control Number 24-AS-20220912095232

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: GETTYSBURG CHRISTIAN HOME	FACILITY NUMBER: 107206609
	VISIT DATE: 01/19/2023

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	LPA Williams attempted to interview Resident 1 with no success. Based on the LPA's observations and interviews, 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 allegation is UNSUBSTANTIATED. An exit interview was conducted and a copy of this report will be provided via e-mail.

SUPERVISOR'S NAME: Serigy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius Williams	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
09/12/2022 and conducted by Evaluator Darius Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20220912095232

FACILITY NAME:	GETTYSBURG CHRISTIAN HOME		FACILITY NUMBER:	107206609
ADMINISTRATOR:	DYER, ELIZABETH		FACILITY TYPE:	740
ADDRESS:	4844 E. GETTYSBURG		TELEPHONE:	(559) 294-9080
CITY:	FRESNO	STATE: CA	ZIP CODE:	93726
CAPACITY:	18	CENSUS: 13	DATE:	01/19/2023
		UNANNOUNCED	TIME BEGAN:	08:34 AM
MET WITH:	Staff Joyce Torres		TIME COMPLETED:	09:08 AM

ALLEGATION(S):

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Resident developed a UTI while in care.
Resident developed dehydration while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Darius Williams conducted a follow up visit. LPA Williams met with staff Joyce Torres and discussed the purpose of the visit. LPA Williams spoke with Administrator Elizabeth Dyer via phone and discussed the purpose of the visit.

In regards to the allegation, resident developed a UTI while in care, according to the Administrator, Staff 1, and an ambulance employee there was no symptoms that lead them to believe Resident 1 had a UTI. Once, R1 was at the hospital testing was conducted to confirm R1 had a UTI.

In regard to the allegation, resident developed dehydration while in care, Witness 2 (W2) reported the statement that R1 was dehydrated, was not accurate and transcribed incorrectly on the SOC 341 report as W2 reported there was no signs or symptoms of R1 being dehydrated.

*Continued on LIC 9099C*

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Serigy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius Williams	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 24-AS-20220912095232

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: GETTYSBURG CHRISTIAN HOME	FACILITY NUMBER: 107206609
	VISIT DATE: 01/19/2023

NARRATIVE

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This agency has investigated the complaint alleging resident developed a UTI while in care and resident developed dehydration while in care. We have found that the complaint was unfounded, which means the allegation could not have happened, and/or is without a reasonable basis, therefore we have dismissed the complaint.

An exit interview was conducted and a copy of this report will be provided via e-mail.

SUPERVISOR'S NAME: Serigy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius Williams	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4