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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107206749
Report Date: 04/05/2023
Date Signed: 04/05/2023 12:28:10 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
12/05/2022 and conducted by Evaluator Alexandria Walton
COMPLAINT CONTROL NUMBER: 24-AS-20221205072226
FACILITY NAME:CEDARBROOK MEMORY CARE COMMUNITYFACILITY NUMBER:
107206749
ADMINISTRATOR:SARAH DENNISFACILITY TYPE:
740
ADDRESS:1425 E. NEES AVETELEPHONE:
(559) 412-2299
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:68CENSUS: 58DATE:
04/05/2023
UNANNOUNCEDTIME BEGAN:
11:58 AM
MET WITH:Administrator, Sarah DennisTIME COMPLETED:
12:44 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident is being overcharged for services
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 04/05/2023, 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 Administrator, Sarah Dennis.

During the course of the investigation, it was found that the facility has been charging R1 for gloves and incontinence supplies. Review of regulations and records revealed that the facility is allowed to charge for gloves and incontinence supplies.

Based on interviews and record review, the allegation: Resident is being overcharged for services is UNSUBSTANTIATED.

No deficiencies issued during this inspection. Exit interview conducted and a copy of this report was discussed and provided to Administrator, Sarah Dennis, 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: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023
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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