107208908-10-3-2022-24-AS-MHON-CJW4TG-20221004192307

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107208908
Report Date: 10/03/2022
Date Signed: 10/03/2022 02:37:04 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
07/29/2022 and conducted by Evaluator Alexandria Walton

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20220729113420

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: 91	DATE:	10/03/2022
		UNANNOUNCED	TIME BEGAN:	12:47 PM
MET WITH:	Administrator, Erik Schuk		TIME COMPLETED:	01:59 PM

ALLEGATION(S):

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Staff did not respond to egress alarm timely, resulting in resident exiting memory care, falling and sustaining an injury

INVESTIGATION FINDINGS:

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On 10/3/2022, 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, Erik Schuck

During the course of the investigation, LPA conducted a facility tour, interviewed staff, and reviewed records.

Based on interviews and records review, staff did not respond timely to the egress alarm, resulting in R1 exiting the facility, falling, and sustaining a head injury requiring that medical attention be sought. Review of the facility Alarm Event Report indicates that staff responded to the egress alarm approximately 34 minutes later.

Based on interviews and records review, the preponderance of evidence standard has been met, therefore the allegation: Staff did not respond to egress alarm timely, resulting in resident exiting memory care, falling and sustaining an injury is SUBSTANTIATED. CONTINUED TO 9099C.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Alexandria Walton	TELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022

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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Control Number 24-AS-20220729113420

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: 10/03/2022

NARRATIVE

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A deficiency is being cited in accordance to California Code of Regulations, Title 22, Division 6 on the attached 9099D. The issuance of civil penalties is currently under review. The details of civil penalties will be outlined in a future report to the facility, if any.

Exit interview conducted and a Plan of Correction was reviewed and developed. A copy of this report and appeal rights were discussed and provided to Administrator, Erik Schuk whose signature on this form confirms receipt of these documents

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Alexandria Walton	TELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022

LIC9099 (FAS) - (06/04)

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Control Number 24-AS-20220729113420

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: 10/03/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 10/04/2022 Section Cited CCR 87468.2(a)(4)	1 2 3 4 5 6 7	87468.2(a)(4): (a) In addition to the rights listed in Section 87468.1...residents...shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee agrees to submit a written statement detailing the steps the facility will take to ensure the requirements for this section are met including the facility's plan to train all staff on emergency prototcols to the Fresno CCL Office by the POC due date.
	8 9 10 11 12 13 14	Based on interviews and record review, the licensee did not ensure R1's needs were met when R1 was able to leave the facility undetected resulting in a fall outside of the facility which is an immediate health and safety risk to residents/clients 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) 341-3274
LICENSING EVALUATOR NAME: Alexandria Walton	TELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022

LIC9099 (FAS) - (06/04)

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