107206749-4-20-2022-24-AS-MHON-CDQURB-20220422154828

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107206749
Report Date: 04/20/2022
Date Signed: 04/20/2022 02:02:37 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
03/11/2022 and conducted by Evaluator Alexandria Walton

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20220311150427

FACILITY NAME:	CEDARBROOK MEMORY CARE COMMUNITY		FACILITY NUMBER:	107206749
ADMINISTRATOR:	LISA POOLE-JOHNSON		FACILITY TYPE:	740
ADDRESS:	1425 E. NEES AVE		TELEPHONE:	(559) 412-2299
CITY:	FRESNO	STATE: CA	ZIP CODE:	93720
CAPACITY:	68	CENSUS: 56	DATE:	04/20/2022
		UNANNOUNCED	TIME BEGAN:	01:44 PM
MET WITH:	Director of Resident Services, Gao Moua		TIME COMPLETED:	02:10 PM

ALLEGATION(S):

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Residents are locked out of their room

INVESTIGATION FINDINGS:

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On 04/20/2022, Licensing Program Analyst (LPA) 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 Director of Resident Services (DRS), Gao Moua

Interviews revealed that residents and resident families were informed of facility staff locking resident doors after a resident exits the apartment to prevent other residents from “wandering” into the wrong apartment and removing items. Facility staff “are on the floor” and are available to unlock the door when requested. Per Administrator, residents are given the option to have a key to the apartment prior to admission to the facility. Based on interviews and record review, the allegation: Residents are locked out of their room 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. An exit interview was conducted with Administrator. A copy of this report was discussed and provided to DRS, Gao Moua, whose signature on this form confirms receipt of this document.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria Walton	TELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2022

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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