107206749-12-19-2022-24-AS-MHON-CMCUDP-20221222142953

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107206749
Report Date: 12/19/2022
Date Signed: 12/19/2022 03:33:05 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
09/16/2022 and conducted by Evaluator Alexandria Walton

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20220916112021

FACILITY NAME:	CEDARBROOK MEMORY CARE COMMUNITY		FACILITY NUMBER:	107206749
ADMINISTRATOR:	SARAH DENNIS		FACILITY TYPE:	740
ADDRESS:	1425 E. NEES AVE		TELEPHONE:	(559) 412-2299
CITY:	FRESNO	STATE: CA	ZIP CODE:	93720
CAPACITY:	68	CENSUS: 56	DATE:	12/19/2022
		UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Administrator, Sarah Dennis		TIME COMPLETED:	03:47 PM

ALLEGATION(S):

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Resident developed pressure injuries while in care
Staff did not assist resident with ambulating
Facility did not meet resident's dietary needs

INVESTIGATION FINDINGS:

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On 12/19/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to deliver findings on the above allegations. 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 an investigation, LPA reviewed facility records and conducted interviews.

Interviews revealed that residents who have pressure wounds / injuries are “turned/repositioned” every one to two hours. Facility staff do not document if/when a resident was repositioned. Facility staff will attempt to assist residents with ambulating throughout the day. If a resident refuses, facility staff will seek assistance from another caregiver. Residents are provided three meals a day including three snacks at 10:30AM, 2:30PM and 7:30PM. Residents have access to beverages throughout the day and facility staff will assist residents with food or beverages as needed. CONTINUED TO 9099C

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: 12/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022

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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Control Number 24-AS-20220916112021

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: CEDARBROOK MEMORY CARE COMMUNITY	FACILITY NUMBER: 107206749
	VISIT DATE: 12/19/2022

NARRATIVE

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Based on interviews conducted, the allegations: resident developed pressure injuries while in care, staff did not assist resident with ambulating, facility did not meet resident's dietary needs are UNSUBSTANTIATED. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

No deficiencies issued.

An exit interview was conducted. A copy of this report was discussed and provided to Administrator, Sarah Dennis, whose signature on this form confirms receipt of this document.

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Alexandria Walton	TELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022

LIC9099 (FAS) - (06/04)

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