107206750-11-29-2021-24-AS-SPIY-C9C25P-20211202160552

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107206750
Report Date: 11/29/2021
Date Signed: 11/29/2021 11:26:48 AM

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
11/08/2021 and conducted by Evaluator Darius Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20211108150245

FACILITY NAME:	A PLACE CALLED HOME RESIDENTIAL CARE 2		FACILITY NUMBER:	107206750
ADMINISTRATOR:	DAVID C MURCHISON		FACILITY TYPE:	740
ADDRESS:	4085 N NEWPORT BAY		TELEPHONE:	(559) 346-1527
CITY:	CLOVIS	STATE: CA	ZIP CODE:	93619
CAPACITY:	6	CENSUS: 6	DATE:	11/29/2021
		UNANNOUNCED	TIME BEGAN:	11:11 AM
MET WITH:	Staff Ronald Linguete		TIME COMPLETED:	11:26 AM

ALLEGATION(S):

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Staff not contacting authorized representative.
Resident not able to have visitors.
Facility does not have a working phone for residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Darius Williams conducted an unannounced follow up complaint visit to deliver findings. LPA Williams met with Staff Ronald Linguete and discussed the purpose of the visit. LPA Williams spoke with Administrator David Murchison via phone and discussed the purpose of the visit. The Administrator provided verbal approval for staff to sign the report.

LPA Williams has conducted interviews, observations, and records reviews.

In regard to the allegation, staff not contacting authorized representative, according to documents provided by the facility, Witness 1 (W1) and Witness 2 (W2) are Resident 1’s (R1) authorized representatives. According, to W2 the facility contacts them with any updates.

*Continued on LIC 9099-C*
.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Serigy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius Williams	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021

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-20211108150245

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: A PLACE CALLED HOME RESIDENTIAL CARE 2	FACILITY NUMBER: 107206750
	VISIT DATE: 11/29/2021

NARRATIVE

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In regard to the allegation, resident not able to have visitors, W1 and W2 reported visiting R1 at the facility. R1 confirmed W1 and W2 visit the facility consistently. Witness 3 reported visiting R1 at the facility on 11/6/2021. According to facility visitor logs, R1 has had 13 visits from family members between 10/23/2021 and 11/6/2021.

In regard to the allegation, facility does not have a working phone, LPA Williams observed a land line cordless phone in the kitchen. LPA Williams contacted the phone, which was functional and working. W1 and W2 both reported speaking to R1 using the facility phone.

On 11/9/2021, the Reporting Party contacted LPA Williams via phone, and stated the concerns are not with the facility and that they would like to retract the allegations against the facility.

This agency has investigated the complaint alleging the above allegations. Based on interviews, observation, and record review, we have found that the complaint was UNFOUNDED, meaning the above allegations could not have happened or is without a reasonable basis, therefore we have dismissed the complaint.

An exit interview was conducted and a copy of this report was provided.

SUPERVISOR'S NAME: Serigy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius Williams	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021

LIC9099 (FAS) - (06/04)

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