107208983-12-3-2021-24-AS-SPIY-C9RRN7-20211216120953

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107208983
Report Date: 12/02/2021
Date Signed: 12/03/2021 02:09:47 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
10/19/2021 and conducted by Evaluator David Ayers

COMPLAINT CONTROL NUMBER: 24-AS-20211019103858

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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Staff do not ensure residents are fed.
Resident's diapers are not being changed.

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. Based off of interviews and records reviewed, the facility has appropriate systems in place for staff to follow in order to ensure residents are fed. Care plans inform staff which residents require assistance being fed. Meals are delivered to residents who are unable to come to the dining areas. Facility staff stated that residents are always fed. Facility staff stated they regularly check and monitor residents to ensure those with diapers are clean and changed. Facility documents hourly checks conducted by staff. 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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