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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107206701
Report Date: 12/08/2023
Date Signed: 12/08/2023 11:09:54 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
11/29/2023 and conducted by Evaluator Alexandria Walton
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20231129110044
FACILITY NAME:VETERANS HOME OF CALIFORNIA-FRESNOFACILITY NUMBER:
107206701
ADMINISTRATOR:SCOTT H. RICHARDSFACILITY TYPE:
740
ADDRESS:2811 W. CALIFORNIA AVENUETELEPHONE:
(559) 493-4400
CITY:FRESNOSTATE: CAZIP CODE:
93706
CAPACITY:186CENSUS: 128DATE:
12/08/2023
UNANNOUNCEDTIME BEGAN:
10:22 AM
MET WITH:Administrator, Scott Richards and Supervising Registered Nurse Priscilla MedinaTIME COMPLETED:
11:23 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff did not notify authorized representative of incident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/8/2023, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct a complaint investigation. LPA introduced self and requested to meet the Administrator. LPA met with and disclosed the purpose of the visit to Administrator, Scott Richards and Supervising Registered Nurse Priscilla Medina.

During the course of the investigation, LPA conducted interviews. Based on interviews conducted, the allegation: Facility staff did not notify authorized representative of incident is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

No deficiencies issued. Exit interview conducted. A copy of this report was discussed and provided to Administrator, Scott Richards, whose signature on this form confirms receipt of this document.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023
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 2
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
11/29/2023 and conducted by Evaluator Alexandria Walton
COMPLAINT CONTROL NUMBER: 24-AS-20231129110044

FACILITY NAME:VETERANS HOME OF CALIFORNIA-FRESNOFACILITY NUMBER:
107206701
ADMINISTRATOR:SCOTT H. RICHARDSFACILITY TYPE:
740
ADDRESS:2811 W. CALIFORNIA AVENUETELEPHONE:
(559) 493-4400
CITY:FRESNOSTATE: CAZIP CODE:
93706
CAPACITY:186CENSUS: 128DATE:
12/08/2023
UNANNOUNCEDTIME BEGAN:
10:22 AM
MET WITH:Administrator, Scott Richards and Supervising Registered Nurse Priscilla MedinaTIME COMPLETED:
11:23 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff did not accept resident back after a hospital discharge
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/8/2023, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct a complaint investigation. LPA introduced self and requested to meet the Administrator. LPA met with and disclosed the purpose of the visit to Administrator, Scott Richards and Supervising Registered Nurse Priscilla Medina.

During the course of the investigation, LPA conducted interviews. Interviews with Administrator and Supervising Registered Nurse (SRN) Priscilla Medina, revealed that upon discharge from the hospital, R1was accepted back to the facility.

This agency has investigated the complaint alleging: Facility staff did not accept resident back after hospital dischage. We have found that the complaint is UNFOUNDED. An exit interview was conducted with Administrator. A copy of this report was discussed and provided to Administrator, Scott Richards, whose signature on this form confirms receipt of this document.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023
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 2