107206929-7-20-2022-24-AS-SPIY-CGPKT4-20220726081031

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107206929
Report Date: 07/20/2022
Date Signed: 07/20/2022 04:37:01 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
02/15/2022 and conducted by Evaluator Katie Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20220215111030

FACILITY NAME:	PAINTBRUSH ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	107206929
ADMINISTRATOR:	JENNIFER VASQUEZ		FACILITY TYPE:	740
ADDRESS:	4356 W ASHLAN AVE		TELEPHONE:	(559) 275-2000
CITY:	FRESNO	STATE: CA	ZIP CODE:	93722
CAPACITY:	110	CENSUS: 87	DATE:	07/20/2022
		UNANNOUNCED	TIME BEGAN:	01:04 PM
MET WITH:	Jennifer Vasquez		TIME COMPLETED:	04:40 PM

ALLEGATION(S):

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Resident sustained a UTI while in care
Resident fell while in care and sustained a fracture

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct a subsequent complaint investigation. LPA met with and explained the elements of the allegations with Administrator (AD) Jennifer Vasquez.

A Record review of Resident (R1’s) file was conducted and did not reveal that R1 had a history of or specific care needs related to UTI. Interviews conducted reveal that R1 experienced increased confusion and care needs during the last weeks at the facility. Based on record review and interview, it cannot be determined that there was a lack in care or supervision by the facility that would have caused R1 to experience a UTI. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. The allegation is UNSUBSTANTIATED.

See LIC9099-C for Continuation

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie Brown	TELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2022

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-20220215111030

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: PAINTBRUSH ASSISTED LIVING AND MEMORY CARE	FACILITY NUMBER: 107206929
	VISIT DATE: 07/20/2022

NARRATIVE

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Record review of R1’s file and interviews reveal that R1 was experiencing increased confusion. The facility had met with and planned with R1’s Responsible Party to move R1 from Assisted Living to Memory Care upon return from a hospitalization due to recent change of condition. Facility Narrative Charting show that the facility was in communication with the family regarding falls and interventions put in place. Based on record review and interview, it is not determined that the resident sustained a fracture due to lack of care and supervision by the facility. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. The allegation is UNSUBSTANTIATED.

No deficiencies cited.

A copy of this report was provided, and an exit interview was conducted with AD.

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie Brown	TELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2022

LIC9099 (FAS) - (06/04)

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