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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107209035
Report Date: 01/18/2024
Date Signed: 01/18/2024 11:41:19 AM

Unfounded


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
10/09/2023 and conducted by Evaluator Les Xiong
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20231009132328
FACILITY NAME:TRUEWOOD BY MERRILL, CLOVISFACILITY NUMBER:
107209035
ADMINISTRATOR:AUDIE L SHERBERGFACILITY TYPE:
740
ADDRESS:675 W ALLUVIAL AVENUETELEPHONE:
(559) 325-8400
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:148CENSUS: DATE:
01/18/2024
UNANNOUNCEDTIME BEGAN:
10:37 AM
MET WITH:Pamela MazonTIME COMPLETED:
12:23 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not ensure residents rooms are kept free of malodors
Facility is over charging resident for services not provided by staff
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) L. Xiong conducted the complaint investigation visit to the facility. I met with General Manager/Administrator Pamela Mazon and informed her the purpose of the visit.
During the course of this investigation LPA reviewed facility files relevant to the complaint investigation. It was determined that the above allegations: Staff do not ensure residents rooms are kept free of malodors, facility is over charging resident for services not provided by staff are UNFOUNDED. The evidence from the investigation indicated R1's POA was properly notified of the rate increase due to change in level of care and there were no malodors except duing time of incontinent. This agency has investigated the complaint alleging (Staff do not ensure residents rooms are kept free of malodors, facility is over charging resident for services not provided by staff ). We have found that the complaint was unfounded, therefore we have dismissed the complaint.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Les XiongTELEPHONE: (559) 410-1772
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
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
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
10/09/2023 and conducted by Evaluator Les Xiong
COMPLAINT CONTROL NUMBER: 24-AS-20231009132328

FACILITY NAME:TRUEWOOD BY MERRILL, CLOVISFACILITY NUMBER:
107209035
ADMINISTRATOR:AUDIE L SHERBERGFACILITY TYPE:
740
ADDRESS:675 W ALLUVIAL AVENUETELEPHONE:
(559) 325-8400
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:148CENSUS: DATE:
01/18/2024
UNANNOUNCEDTIME BEGAN:
10:37 AM
MET WITH:Pamela MazonTIME COMPLETED:
12:23 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not ensure soiled linens are removed from residents rooms
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
During this visit LPA delivered investigation findings regarding the above allegation.The Department has investigated the complaint alleging: Staff do not ensure soiled linens are removed from residents rooms. Based on the interviews conducted and/or records review the above allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Les XiongTELEPHONE: (559) 410-1772
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 2