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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107206609
Report Date: 01/23/2023
Date Signed: 01/31/2023 02:01:28 PM

Substantiated


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
10/26/2022 and conducted by Evaluator Katie Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20221026103923
FACILITY NAME:GETTYSBURG CHRISTIAN HOMEFACILITY NUMBER:
107206609
ADMINISTRATOR:DYER, ELIZABETHFACILITY TYPE:
740
ADDRESS:4844 E. GETTYSBURGTELEPHONE:
(559) 294-9080
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY:18CENSUS: 13DATE:
01/23/2023
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Joyce TorresTIME COMPLETED:
02:36 PM
ALLEGATION(S):
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Resident has access to hazardous materials while in care
Resident's room is not properly maintained while in care
Commons areas are posing as a risk for the residents
Staff are not properly maintaining the facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Katie Brown arrived at the facility to conduct a subsequent complaint inspection as well as deliver investigation findings. Administrator (AD) Elizabeth Dyer was contacted and unable to come to the facility. AD authorized Staff (S1) Joyce Torres to meet with LPA and sign reports.

During the visit, LPA toured the facility and conducted interviews.

LPA observed unsecured cabinets contacining chemicals and tools which were accessable to residents.
LPA observed resident rooms with dirty floors, dusty furniture and broken closet doors.
LPA observed broken plate with sharp edges laying in a sink which was accessible to residents.
LPA observed dead insects and multiple rat traps in common area, accessible to residents.
LPA observed unlocked storage room in the facility full of furniture and miscalaneous items.

See LIC9099C for continuation of this report.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2023
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 5
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
10/26/2022 and conducted by Evaluator Katie Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20221026103923

FACILITY NAME:GETTYSBURG CHRISTIAN HOMEFACILITY NUMBER:
107206609
ADMINISTRATOR:DYER, ELIZABETHFACILITY TYPE:
740
ADDRESS:4844 E. GETTYSBURGTELEPHONE:
(559) 294-9080
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY:18CENSUS: 13DATE:
01/23/2023
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Joyce TorresTIME COMPLETED:
02:36 PM
ALLEGATION(S):
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2
3
4
5
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7
8
9
Residents are being left unattended
INVESTIGATION FINDINGS:
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7
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13
Licensing Program Analyst (LPA) Katie Brown arrived at the facility to conduct a subsequent complaint inspection as well as deliver investigation findings. Administrator (AD) Elizabeth Dyer was contacted and unable to come to the facility. AD authorized Staff (S1) Joyce Torres to meet with LPA and sign reports.

During the visit, LPA toured the facility and conducted interviews. Resident and staff were interviewed and state that at least one caregiver and/or the Administrator is at the facility at all times. A staff roster and shift times were submitted and reviewed. Based on observation, interview and record review the above allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur.

An exit interview was conducted and a copy of this report was left with Joyce Torres, whose signature confirms receipt of these documents.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2023
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 5
Control Number 24-AS-20221026103923
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: 01/23/2023
NARRATIVE
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Based on the above observations by the LPA, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited in accordance with California Code of Regulations on the attached LIC 9099-D.



An exit interview was conducted and Plan of Correction was developed. A copy of this report and Appeal Rights were discussed and left with Joyce Torres, whose signature on this form confirms receipt of these documents.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 24-AS-20221026103923
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/24/2023
Section Cited
CCR
87309(a)(1)
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87309 Storage Space (a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. (1) Storage areas for poisons, and firearms and other dangerous weapons shall be locked.
This requirement was not met as evidenced by:
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A lock has been placed on the cabinet and the razor was removed and properly locked. The deficiency has been cleared.

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Licensee did not ensure chemicals and cleaning supplies and items which could pose danger were inaccessable to residents. LPA observed a razor in an unlocked shower room, cleaning and paint supplies stored in an unlocked cabinet in a common area.

This poses an immediate health, safety or personal rights risk to persons in care.
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Type B
01/23/2023
Section Cited
CCR
87307(d)(2)
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87307 Personal Accommodations and Services (d) The following space and safety provisions shall apply to all facilities: (2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment.
This requirement was not met as evidenced by:
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Administrator has agreed to repair or replace the sliding closet door. The housekeeping procedure and schedule will be reviewed with staff. A sign in sheet will be provided to CCLD as proof of in-service. Sign in sheet will include the training topic, trainer and date which will be submitted by the due date.
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Licensee did not ensure that the facility was maintained in good repair to provide a safe environment to residents in care. LPA observed dirty bedroom floors, broken closet doors in resident room and dusty bedroom furniture in resident rooms.
This poses a potential health, safety or personal rights risk to persons in care.
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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: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 24-AS-20221026103923
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/24/2023
Section Cited
CCR
87705(f)(1)
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87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s).
This requirement was not met as evidenced by:
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A lock was placed on the cabinet containing tools. The traps were removed. The doorknob and lock were replaced on the storage room door. Deficiency has been cleared.
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Licensee did not ensure that tools and vermon traps were inaccessable to residents in common areas. LPA observed an unlocked storage room filled with furniture, tools, cleaning supplies, matresses and miscellaneous items that could be a risk to resident safety.
This poses an immediate health, safety or personal rights risk to persons in care.
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Type B
01/30/2023
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
This requirement was not met as evidenced by:
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Administrator has agreed to conduct a deep clean to the small laundty room. Pictures will be submitted as evidence that the cleaning has been completed. Additionally, cords on the ground in common areas will be appropriately maintained to ensure residents will not trip. Pictures will be provided to ccld via email by the due date.
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Licensee did not ensure that the facility was kept clean, safe, sanitary and in good repair. LPA observed a broken plate with sharp edges, oral care pick and dead insects in a sink in common area. Electrical cords were observed laying on the ground tangled up around televisions and lamps throughout the facility common areas. This poses a potential health, safety or personal rights risk to persons in care.
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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: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5