107208866-8-3-2021-24-AS-MHON-C66LZN-20210823091210

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107208866
Report Date: 08/03/2021
Date Signed: 08/03/2021 02:39:20 PM

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
04/06/2021 and conducted by Evaluator Alexandria Walton

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20210406090524

FACILITY NAME:	VISTA ELDERLY CARE FACILITY		FACILITY NUMBER:	107208866
ADMINISTRATOR:	ABALOS, CORA		FACILITY TYPE:	740
ADDRESS:	8893 NORTH SIERRA VISTA AVE		TELEPHONE:	(559) 470-2062
CITY:	FRESNO	STATE: CA	ZIP CODE:	93720
CAPACITY:	6	CENSUS: 3	DATE:	08/03/2021
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Assistant Administrator, Leticia Rodriguez		TIME COMPLETED:	10:05 AM

ALLEGATION(S):

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Facility staff inappropriately touched resident
Facility staff yelled at resident
Facility staff pulled resident's hair

INVESTIGATION FINDINGS:

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On 08/03/2021, Licensing Program Analysts (LPAs) Walton and Yang arrived unannounced to deliver findings on the above allegations. LPAs introduced themselves and requested to meet with the Administrator. Assistant Administrator (AA), Leticia Rodriguez arrived a short time later. LPAs disclosed the purpose of the visit with AA.

Duirng the course of the investigation LPA reviewed records and interviewed staff.

Based on interviews and record review the above allegations are found to be UNSUBSTANTIATED. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

No deficiencies issued. An exit interview was conducted with AA. A copy of this report was discussed and will be provided via email as a COVID-19 precautionary measure, an electronic read receipt confirms receiving this document. Faciltiy Representative signature on file.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria Walton	TELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021

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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