<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107209000
Report Date: 01/12/2021
Date Signed: 01/12/2021 12:18:30 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
11/03/2020 and conducted by Evaluator See Moua
COMPLAINT CONTROL NUMBER: 24-AS-20201103121924
FACILITY NAME:LAURITE SENIOR CARE HOMEFACILITY NUMBER:
107209000
ADMINISTRATOR:DAVIS, MARITAFACILITY TYPE:
740
ADDRESS:5478 E LAURITE AVETELEPHONE:
(559) 246-1561
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY:6CENSUS: 3DATE:
01/12/2021
UNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Marita Davis, Administraotr TIME COMPLETED:
12:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident needs not being meet.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) S. Moua contacted the facility via telephone to deliver findings due to COVID-19 and pre-cautionary measures. LPA identified herself and discussed the complaint allegation and finding with Administrator Marita Davis.

Facility staff was interviewed. Records were obtained and reviewed. R1, referenced in the complaint is not a current resident of the facility. The caregiver mentioned in the complaint is not associated to the facility and has never worked at the facility. Based on interviews conducted and records reviewed, this complaint is Unfounded.

Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: See MouaTELEPHONE: (559) 650-7904
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2021
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 2