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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107208908
Report Date: 03/23/2021
Date Signed: 03/23/2021 02:17:01 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
06/29/2020 and conducted by Evaluator Alexandria Walton
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20200629152800
FACILITY NAME:WESTMONT OF FRESNOFACILITY NUMBER:
107208908
ADMINISTRATOR:HAMILTON, PAMELAFACILITY TYPE:
740
ADDRESS:7442 & 7468 N MILLBROOK AVETELEPHONE:
(858) 729-6720
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:155CENSUS: DATE:
03/23/2021
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Executive Director, Pamela HamiltonTIME COMPLETED:
01:46 PM
ALLEGATION(S):
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Staff are not responding timely to resident needs.
INVESTIGATION FINDINGS:
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On 3/23/2021, Licensing Program Analyst (LPA) A. Walton contacted Executive Director (ED), Pamela Hamilton to conduct a subsequent complaint investigation via telephone due to COVID-19 and precautionary measures. The purpose of today’s investigation is to deliver findings on the above allegation.

During the course of the investigation, LPA conducted staff interviews and reviewed facility records. Consistent statements from facility staff determined that the facility has insufficient staffing to meet residents needs.

Based on interviews and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

CONTINUED TO LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2021
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-20200629152800
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: 03/23/2021
NARRATIVE
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A deficiency is being cited on the attached 9099D in accordance to California Code of Regulations, Title 22, Division 6, Section 87411(a).

A Plan of Correction was developed and reviewed with ED. Exit interview conducted. A copy of this report and Appeal Rights were discussed and provided to ED via email and an electronic read receipt confirms receiving these documents. Facility Representative signature on file.

SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 24-AS-20200629152800
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: 03/23/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/02/2021
Section Cited
CCR
87411(a)
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87411 Personnel Requirements(a): Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by:
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Licensee will review section 87411 Personnel Requirements and submit a statement detailing how the facility will ensure personnel is, at all times, sufficient in numbers to meet resident needs by 4/2/2021
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Based on interviews and records review, the facility did not ensure facility personnel was sufficient in numbers to meet resident needs. This poses a potential health and safety risk to residents in care.
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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 HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2021
LIC9099 (FAS) - (06/04)
Page: 3 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
06/29/2020 and conducted by Evaluator Alexandria Walton
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20200629152800

FACILITY NAME:WESTMONT OF FRESNOFACILITY NUMBER:
107208908
ADMINISTRATOR:HAMILTON, PAMELAFACILITY TYPE:
740
ADDRESS:7442 & 7468 N MILLBROOK AVETELEPHONE:
(858) 729-6720
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:155CENSUS: DATE:
03/23/2021
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Executive Director, Pamela HamiltonTIME COMPLETED:
01:46 PM
ALLEGATION(S):
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9
Facility did not report changes in condition to resident’s physician.
INVESTIGATION FINDINGS:
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5
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On 3/23/2021, Licensing Program Analyst (LPA) A. Walton contacted Executive Director (ED), Pamela Hamilton to conduct a subsequent complaint investigation via telephone due to COVID-19 and precautionary measures. The purpose of today’s investigation is to deliver findings on the above allegation.

The Department investigated the above allegation and based on interviews and records review, there is not a preponderance of evidence to prove or disprove that the allegation did or did not occur, therefore the allegations are UNSUBSTANTIATED.

No deficiencies issued.

An exit interview was conducted with ED. A copy of this report was discussed and provided via email and an electronic read receipts confirms receiving these documents.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4