107208983-3-17-2022-24-AS-SPIY-CCMR2U-20220318123856

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107208983
Report Date: 03/08/2022
Date Signed: 03/17/2022 10:40:09 AM

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
12/20/2021 and conducted by Evaluator David Ayers

COMPLAINT CONTROL NUMBER: 24-AS-20211220095642

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: 25	DATE:	03/08/2022
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Beronica Galindo - Executive DIrector		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility is not allowing residents to return to the facility after hospitalization.
Facility does not have sufficient staff to meet the needs of the residents in care.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On this date, Licensing Program Analyst (LPA) D. Ayers arrived unannounced to deliver complaint findings. LPA identified himself and discussed the purpose of the visit with Executive Director Beronica Galindo.

During the course of the investigation, the Department conducted interviews, toured the facility, and reviewed records. In December of 2021, Resident 1(R1) arrived at the facility from another facility without prior warning. Facility staff determined that this was an unsafe transfer and that they could not meet the needs of R1. Facility staff coordinated with hospital staff and the responsible party of R1 to have them admitted to a facility that coud meet their needs. The facility has hired and trained new staff, and was operating at below half of capacity of residents. The allegations are Unsubstantiated. No deficiencies were cited. A copy of this 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: 03/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2022

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 3