107208983-9-21-2021-24-AS-SPIY-C7WM95-20211018092412

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107208983
Report Date: 09/20/2021
Date Signed: 09/21/2021 08:32:15 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
06/11/2021 and conducted by Evaluator David Ayers

COMPLAINT CONTROL NUMBER: 24-AS-20210611140247

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: 37	DATE:	09/20/2021
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Jennifer Fowler - Executive Director		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Facility staff did not seek timely medical care for resident
Resident sustained a pressure injury while in care

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 Executive Director Jennifer Fowler and anounced the purpose of the visit.

During the course of the investigation, the Department conducted interviews, reviewed records, and conducted facility inspections. According to records and staff interviews, facility staff did seek timely care for Resident 1 (R1). Facility staff acted in accordance with R1's hospice care plan. The hospice team did not report neglect or questionable practice by facility staff. The hospice team was aware of R1's bowel issues and frequent constipation. R1's pressure injury was being cleaned and treated by facility staff and the hospice team. The above allegations are unsubstantiated. No deficiency was observed. Exit interview conducted, and a copy of this report provided 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: 09/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2021

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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