107209035-7-4-2023-24-AS-BCHN-CTNU69-20230712151758

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107209035
Report Date: 07/03/2023
Date Signed: 07/04/2023 10:30:17 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 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
03/22/2023 and conducted by Evaluator Vadim Gorban

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20230322154417

FACILITY NAME:	TRUEWOOD BY MERRILL, CLOVIS		FACILITY NUMBER:	107209035
ADMINISTRATOR:	ROBERT HUNTLEY		FACILITY TYPE:	740
ADDRESS:	675 W ALLUVIAL AVENUE		TELEPHONE:	(559) 325-8400
CITY:	CLOVIS	STATE: CA	ZIP CODE:	93611
CAPACITY:	148	CENSUS: 118	DATE:	07/03/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	General Manager, Pamela Mazon		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff do not ensure resident's needs are met
Facility food services is inadequate
Staff do not keep the resident's rooms clean
Licensee did not provide a notice of fee increase with a general description of the additional costs to the resident or the resident's authorized representative

INVESTIGATION FINDINGS:

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On 7/03/23, Licensing Program Analyst (LPA) V Gorban visited facility stated above to deliver findings. LPA met with General Manager (GM) Pamela Mazon, explained the reason for the visit and toured facility inside and out. LPA reviewed residents’ files and discussed findings with GM.
Allegation: Staff do not ensure resident's needs are met
Department investigated this complaint. Based on interviews, records reviews, and observations conducted on 3/29/23 this allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.
Allegation: Facility food services is inadequate
Department investigated this complaint. Based on observations, interviews and records review conducted on 3/29/23 this allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim Gorban	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2023

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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Control Number 24-AS-20230322154417

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: TRUEWOOD BY MERRILL, CLOVIS	FACILITY NUMBER: 107209035
	VISIT DATE: 07/03/2023

NARRATIVE

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Allegation: Staff do not keep the resident's rooms clean

Department investigated this complaint. Based on observation, interviews and records reviews conducted on 3/29/23 this allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Allegation: Licensee did not provide a notice of fee increase with a general description of the additional costs to the resident or the resident's authorized representative

Department investigated this complaint. Based on observations, interviews, and record reviews conducted on 3/29/23 this allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

No citations were issued on this visit. Exit interview conducted, report signed, printed, and copy of this report provided to GM for facility records.

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim Gorban	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2023

LIC9099 (FAS) - (06/04)

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