107206701-6-9-2023-24-AS-MHON-CSRVL8-20230613163130

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107206701
Report Date: 06/09/2023
Date Signed: 06/09/2023 10:55:06 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
02/22/2023 and conducted by Evaluator Alexandria Walton

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20230222155337

FACILITY NAME:	VETERANS HOME OF CALIFORNIA-FRESNO		FACILITY NUMBER:	107206701
ADMINISTRATOR:	SCOTT H. RICHARDS		FACILITY TYPE:	740
ADDRESS:	2811 W. CALIFORNIA AVENUE		TELEPHONE:	(559) 493-4400
CITY:	FRESNO	STATE: CA	ZIP CODE:	93706
CAPACITY:	186	CENSUS: 128	DATE:	06/09/2023
		UNANNOUNCED	TIME BEGAN:	10:09 AM
MET WITH:	Standards Compliance Coordinator, Cheryl Cardoza and Administrator, Scott Richards		TIME COMPLETED:	11:10 AM

ALLEGATION(S):

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Staff left resident in feces for an extended period resulting in hospitalization

INVESTIGATION FINDINGS:

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On 06/09/2023, Licensing Program Analyst (LPA) Walton arrived unannounced to deliver findings on the above allegation. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Standards Compliance Coordinator, Cheryl Cardoza and Administrator, Scott Richards.

During today's visit LPA conducted staff interviews. Based on record review, the allegation: Staff left resident in feces for an extended period resulting in hospitalization 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 and a copy of the 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 Hoffmann	TELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Alexandria Walton	TELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

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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