107206929-8-17-2022-24-AS-SPIY-CKUM7E-20221104092125

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107206929
Report Date: 08/17/2022
Date Signed: 08/17/2022 12:44:36 PM

Unfounded

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
08/09/2022 and conducted by Evaluator Katie Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20220809115404

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: 86	DATE:	08/17/2022
		UNANNOUNCED	TIME BEGAN:	09:32 AM
MET WITH:	Kim Santos		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff refused to provide resident with copies of his monthly payment statements

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Katie Brown arrived at the facility unannounced to conduct the 10-day complaint investigation visit. LPA met with and explained the elements of the allegation with Kim Santos, Business Office Manager (S1).

During the course of the investigation LPA conducted interviews as well as reviewed Resident (R1’s) facility file. Based on interviews and record review, it is determined that the allegation: Staff refused to provide resident with copies of R1’s monthly payment statements is UNFOUNDED. S1 has spoken to R1 and mailed documents including “Resident Detail Ledger” which includes a description of services and payments to the address R1 provided. R1’s Responsible Party confirmed that the facility has provided requested documents. This agency has investigated the complaint. We have found that the complaint was unfounded, therefore we have dismissed the complaint.

No citations were issued during this visit. An exit interview was conducted and a copy of this report was provided to Kim Santos.

Unfounded

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: 08/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022

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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