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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107206814
Report Date: 04/20/2022
Date Signed: 04/20/2022 01:24:51 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
03/21/2022 and conducted by Evaluator Alexandria Walton
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20220321145934
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: 5DATE:
04/20/2022
UNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Administrator, LeShay DustinTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident was left in soiled diaper for extended period of time
Meals served to residents do not consist of an appropriate variety of foods
Staff sleep at the facility during their working hours
Illegal eviction
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 04/20/2022, 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, LeShay Dustin.

Based on interviews conducted with staff and residents, and record review, the allegations: Resident was left in soiled diaper for extended period of time, Meals served to residents do not consist of an appropriate variety of foods, and staff sleep at the facility during their working hours and Illegal eviction is UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

No deficiencies issued during this inspection. An exit interview was conducted with Administrator. A copy of this report was discussed and provided to Administrator, LeShay Dustin, whose signature on this form confirms receipt of this document.
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: 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)
Page: 1 of 2
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
03/21/2022 and conducted by Evaluator Alexandria Walton
COMPLAINT CONTROL NUMBER: 24-AS-20220321145934

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: 5DATE:
04/20/2022
UNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Administrator, LeShay DustinTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is operating outside license terms and conditions
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 04/20/2022, 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, LeShay Dustin.

This agency has investigated the complaint alleging: Facility is operating outside license terms and condition. We have found that the complaint is UNFOUNDED meaning the allegation was false, could not have happened and/or is without a reasonable basis.

No deficiencies issued. An exit interview was conducted with Administrator. A copy of this report was discussed and provided to Administrator, LeShay Dustin, whose signature on this form confirms receipt of this document.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (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)
Page: 2 of 2