107208908-4-13-2022-24-AS-MHON-CDMR74-20220419124544

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107208908
Report Date: 04/13/2022
Date Signed: 04/13/2022 03:11:06 PM

Substantiated

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
02/03/2022 and conducted by Evaluator Alexandria Walton

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20220203130953

FACILITY NAME:	WESTMONT OF FRESNO		FACILITY NUMBER:	107208908
ADMINISTRATOR:	HAMILTON, PAMELA		FACILITY TYPE:	740
ADDRESS:	7442 & 7468 N MILLBROOK AVE		TELEPHONE:	(858) 729-6720
CITY:	FRESNO	STATE: CA	ZIP CODE:	93720
CAPACITY:	155	CENSUS: 75	DATE:	04/13/2022
		UNANNOUNCED	TIME BEGAN:	01:46 PM
MET WITH:	Administrator, Pamela Hamilton		TIME COMPLETED:	01:47 PM

ALLEGATION(S):

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Staff do not respond timely to resident call due to insufficient staffing

INVESTIGATION FINDINGS:

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Substantiated

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: 04/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 4

Control Number 24-AS-20220203130953

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: WESTMONT OF FRESNO	FACILITY NUMBER: 107208908
	VISIT DATE: 04/13/2022

NARRATIVE

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Based on observation and interviews, the preponderance of evidence standard has been met, therefore the allegation: Staff do not respond timely to resident call due to insufficient staffing is found to be SUBSTANTIATED

A deficiency is being cited in accordance to California Code of Regulations, Title 22, Division 6, see attached 9099D.

An exit interview was conducted, and a Plan of Correction was reviewed and developed with Administrator. A copy of this report and appeal rights were discussed and provided to Administrator, Pamela Hamilton, whose signature on this form confirms receipt of this document.

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria Walton	TELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
02/03/2022 and conducted by Evaluator Alexandria Walton

COMPLAINT CONTROL NUMBER: 24-AS-20220203130953

FACILITY NAME:	WESTMONT OF FRESNO		FACILITY NUMBER:	107208908
ADMINISTRATOR:	HAMILTON, PAMELA		FACILITY TYPE:	740
ADDRESS:	7442 & 7468 N MILLBROOK AVE		TELEPHONE:	(858) 729-6720
CITY:	FRESNO	STATE: CA	ZIP CODE:	93720
CAPACITY:	155	CENSUS:	DATE:	04/13/2022
		UNANNOUNCED	TIME BEGAN:	01:46 PM
MET WITH:	Administrator, Pamela Hamilton		TIME COMPLETED:	01:47 PM

ALLEGATION(S):

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Facility failed to provide appropriate transportation for residents

INVESTIGATION FINDINGS:

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On 04/13/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to deliver findings on the above allegation. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Administrator, Pamela Hamilton.

During the investigation, LPA interviewed residents, conducted a facility tour and reviewed records. Based on observation and interviews conducted with residents and staff, the allegations: Facility failed to provide appropriate transportation for residents 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.

No deficiencies issued during this inspection. An exit interview was conducted with Administrator. A copy of this report was discussed and provided to Administrator, Pamela Hamilton, whose signature on this form confirms receipt of this document.

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: 04/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 24-AS-20220203130953

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: WESTMONT OF FRESNO	FACILITY NUMBER: 107208908
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/13/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/13/2022 Section Cited CCR 87411(d)(3)	1 2 3 4 5 6 7	(d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following… (3) Skill and knowledge required to provide necessary resident care and supervision… This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee agrees to submit a written statement detailing the facilities plan to train staff on responding to the residents’ emergency call button timely to the Fresno CCL office by the POC due date.
	8 9 10 11 12 13 14	Based on observation and interviews, the licensee did not ensure the above requirement was met as evidenced by facility staff not responding to residents timely. This poses a potential health and safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria Walton	TELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 4