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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107206814
Report Date: 03/08/2022
Date Signed: 03/08/2022 01:35:56 PM



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
01/20/2022 and conducted by Evaluator Alexandria Walton
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20220120155120
FACILITY NAME:COPPER RIVER RETIREMENT GROUP/SHEAFACILITY NUMBER:
107206814
ADMINISTRATOR:CHRIS CONROYFACILITY TYPE:
740
ADDRESS:2617 E. SHEA DRIVETELEPHONE:
(559) 325-7383
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:6CENSUS: 6DATE:
03/08/2022
UNANNOUNCEDTIME BEGAN:
11:54 AM
MET WITH:Administrator, Shay DustinTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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9
Resident's care needs are not being met
Staff left resident in soiled clothing for an extended period of time
INVESTIGATION FINDINGS:
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On 03/08/2022, Licensing Program Analyst (LPA) A. Walton arrived unannounced to conduct a subsequent complaint investigation. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. Facility staff contacted Administrator, Shay Dustin. Administrator arrived a short time later.

Today's inspection included staff interviews.

Based on interviews conducted with staff and residents, the allegations: Resident's care needs are not being met and Staff left resident in soiled clothing for an extended period of time are UNSUBSTANTIATED. Although the allegations 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. A copy of this report will be provided to Administrator via email due to COVID-19 precautionary measures. Report signed on site by Facility Representative.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2022
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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