107208983-12-3-2021-24-AS-SPIY-C9RRM7-20211216120815

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107208983
Report Date: 12/02/2021
Date Signed: 12/03/2021 02:07:28 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
10/08/2021 and conducted by Evaluator David Ayers

COMPLAINT CONTROL NUMBER: 24-AS-20211008123539

FACILITY NAME:	SOMERFORD PLACE-FRESNO		FACILITY NUMBER:	107208983
ADMINISTRATOR:	FOWLER, JENNIFER		FACILITY TYPE:	740
ADDRESS:	6075 N. MARKS		TELEPHONE:	(559) 446-6226
CITY:	FRESNO	STATE: CA	ZIP CODE:	93711
CAPACITY:	64	CENSUS: 29	DATE:	12/02/2021
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Beronica Galindo - Business Office Manager		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Facility is short staffed.
Staff failed to care for resident(s) wounds while in care.
Unqualified staff administering medication.

INVESTIGATION FINDINGS:

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On this date, Licensing Program Analyst(LPA) D. Ayers arrived at the facility unannounced to deliver complaint findings. LPA met with Beronica Galindo - Business Office Manager and announced the purpose of the visit.

During the course of the investigation, the Department conducted interviews, reviewed records, and conducted facility inspections. Beginning 10/1/2021, facility staffing had been increased and augmented by temporary staff from an outside agency. Based off of records, the facility had enough staff to meet the needs of the residents. The licensee had been actively attempting to hire permanent staff. A nurse consultant had been hired to provide support to staff. Residents with wounds are seen weekly by a physician and are routinely cared for by staff. Per medication records and interviews, no unqualified staff were administering medication. The above allegations are unsubstantiated. Exit interview conducted. A copy of the report was provided to the licensee via email.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Andy Xiong	TELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: David Ayers	TELEPHONE: (559) 650-7925
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021

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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