107206895-7-1-2024-24-AS-SMOA-D9NLF3-20241002084227

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107206895
Report Date: 07/01/2024
Date Signed: 07/01/2024 05:20:45 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
06/24/2024 and conducted by Evaluator Kelly J. McClurg

COMPLAINT CONTROL NUMBER: 24-AS-20240624145043

FACILITY NAME:	ARC FRESNO/MADERA COUNTIES, KERMAN TRAINING CTR.		FACILITY NUMBER:	107206895
ADMINISTRATOR:	THOMPSON-FERNANDEZ,ANDRINA		FACILITY TYPE:	775
ADDRESS:	14550 W. CALIFORNIA AVENUE		TELEPHONE:	(559) 547-2692
CITY:	KERMAN	STATE: CA	ZIP CODE:	93630
CAPACITY:	100	CENSUS:	DATE:	07/01/2024
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Case Manager (CM) Jessica Figueroa; Program Manager (PM) Adrina Fernandez;		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Staff did not notice residents change in condition

INVESTIGATION FINDINGS:

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An unannounced Complaint visit was conducted by Licensing Program Analyst (LPA) K. MccClurg. LPA met with Case Manager (CM) Jessica Figueroa. LPA introduced self, provided business card, stated purpose of visit, & was allowed to proceed. Program Manager (PM) Andrina Fernandez joined CM & LPA during visit.

Occurances of day in question for Client (C1) reviewed, including activities & program observations. All information indicates that C1 did not exhibit any signs or express any discomfort or stated not feelling well. Per program,C1 is verbal, able to express self, including sharing information without prompting. C1 left program appearing to be fine & not stating otherwise. C1 spend 2 hours in transport by 3rd party prior to arriving at residence.

The Department has investigated the above allegation & determined the finding to be: UNSUBSTANTIATED.

Exit interview conducted with PM. Report provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024

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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