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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107208775
Report Date: 07/18/2024
Date Signed: 07/19/2024 07:49:28 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 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
06/20/2024 and conducted by Evaluator Sarah Hurt
COMPLAINT CONTROL NUMBER: 24-AS-20240620104043
FACILITY NAME:MI CASITA CARE HOME IIIFACILITY NUMBER:
107208775
ADMINISTRATOR:JAIME, JUDITFACILITY TYPE:
735
ADDRESS:233 W NORWICH AVETELEPHONE:
(559) 349-2951
CITY:CLOVISSTATE: CAZIP CODE:
93612
CAPACITY:4CENSUS: 4DATE:
07/18/2024
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Adminstrator, Carmen MurosTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not provide a comfortable temperature for resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility to investigate a complaint on the allegations above. LPA met with facility Administrator Carmen Muros, and explained the purpose of today's visit.

Regarding the allegation Staff did not provide a comfortable temperature for resident. LPA Hurt observed Resident 1's room to measure 81 degrees (within regulation.) LPA Hurt interviewed Resident 1 who clearly stated he is not hot inside the room. Based on observation, and interviews conducted during this investigation by Department of Social Services staff this allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Exit interview conducted with Adminstrator Carmen Muros, and a copy of this report provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
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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