107209035-10-10-2022-24-AS-MHON-CK4T8E-20221011143012

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107209035
Report Date: 10/10/2022
Date Signed: 10/10/2022 09:12:15 AM

Unsubstantiated

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
09/01/2022 and conducted by Evaluator Mai Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20220901110728

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: 86	DATE:	10/10/2022
		UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Administrator Rob Huntley		TIME COMPLETED:	09:15 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Neglect/lack of care and/or supervision resulting in injury to resident

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 10/10/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct complaint investigation visit and deliver complaint finding on the above allegation. LPA introduced self, stated the purpose of the visit, and met with Administrator Rob Huntley.

During the course of the investigation, records reviewed, and interviews were conducted with staff. The facility sought immediate medical attention during the incident of R1’s fall.

It could not be proven or disproven that the facility’s lack of care or neglect of supervisor result in injury to the resident. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is UNSUBSTANTIATED. No deficiencies issued. Exit Interview was conducted. A copy of this report was provided to the Administrator.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Mai Yang	TELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2022

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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