107208983-9-21-2021-24-AS-SPIY-C7ZTU6-20211021150149

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107208983
Report Date: 09/20/2021
Date Signed: 09/21/2021 09:02:06 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
07/20/2021 and conducted by Evaluator David Ayers

COMPLAINT CONTROL NUMBER: 24-AS-20210720145855

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):

1
2
3
4
5
6
7
8
9

Residents records are not updated
Resident has gangrene
Staff did not ensure resident was seen by a physician

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 at the facility unannounced to deliver complaint findings. LPA met with Executive Director Jennifer Fowler and announced the purpose of the visit.

During the course of the investigation, the Department conducted interviews, reviewed records, and conducted facility inspections. Based on record reviews, resident records were updated and met regulatiry requirements. Resident 1(R1) was receiveing wound care from a physician for an unstagable pressure injury. R1 was not diagnosed with gangrene. The above alleations 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: 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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