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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107209035
Report Date: 02/25/2025
Date Signed: 02/25/2025 10:34:13 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 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
09/26/2024 and conducted by Evaluator Jacques Leffall
COMPLAINT CONTROL NUMBER: 24-AS-20240926113818
FACILITY NAME:TRUEWOOD BY MERRILL, CLOVISFACILITY NUMBER:
107209035
ADMINISTRATOR:MAZON, PAMELAFACILITY TYPE:
740
ADDRESS:675 W ALLUVIAL AVENUETELEPHONE:
(559) 325-8400
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:148CENSUS: 111DATE:
02/25/2025
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Administrator: Michelle RamosTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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9
Questionable death
INVESTIGATION FINDINGS:
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5
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7
8
9
10
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12
13
On 2/25/225 at 8:30 am Licensing Program Analyst (LPA) J. Leffall conducted a subsequent complaint visit to deliver findings on above allegations. LPA met with Administrator A1 Michelle Ramos and stated purpose of visit.

The department conducted interviews and reviewed records. Based on the information obtained, the above allegation is unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Jacques Leffall
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 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
09/26/2024 and conducted by Evaluator Jacques Leffall
COMPLAINT CONTROL NUMBER: 24-AS-20240926113818

FACILITY NAME:TRUEWOOD BY MERRILL, CLOVISFACILITY NUMBER:
107209035
ADMINISTRATOR:MAZON, PAMELAFACILITY TYPE:
740
ADDRESS:675 W ALLUVIAL AVENUETELEPHONE:
(559) 325-8400
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:148CENSUS: 111DATE:
02/25/2025
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Administrator: Michelle RamosTIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not seek medical care in a timely manner for resident in care

Staff did not report resident incidents to appropriate parties

Staff did not safeguard resident's personal belongings

Staff did not ensure resident was dressed appropriately
INVESTIGATION FINDINGS:
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2
3
4
5
6
7
8
9
10
11
12
13
On 2/25/225 at 8:30 am Licensing Program Analyst (LPA) J. Leffall conducted a subsequent complaint visit to deliver findings on above allegations. LPA met with Administrator A1 Michelle Ramos and stated purpose of visit.The Department conducted interviews and reviewed records. Based on the interviews conducted, facility staff failed to contact or properly notify hospice, leading to the resident receiving delayed medical attention. Interviews conducted confirmed that the facility did not report falls to the resident’s responsible parties, disposed of the resident’s bedsheets, and that the facility failed to ensure the resident was properly dressed. The preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. See citations on the attached LIC. 9099D per Title 22. The issuance of additional civil penalties is pending and currently under review. The details of additional civil penalties will be outlined in a future report to the facility, if any.

Exit Interview conducted. Appeal Rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Jacques Leffall
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
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 4
Control Number 24-AS-20240926113818
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: TRUEWOOD BY MERRILL, CLOVIS
FACILITY NUMBER: 107209035
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/26/2025
Section Cited
CCR
87411(d)(5)
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7
Personnel Requirements

Staff did not seek medical care in a timely manner for resident in care

(d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance:

(5) Knowledge necessary in order to recognize early signs of illness and the need for professional help.
Based on interviews conducted and records review, the facility delayed seeking medical attention for R1 which poses an immediate health, safety or personal rights risk to persons in care.
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7
Licensee agrees to contact hospice immediately concerning resident's health and safety. Licensee agreess to have staff conduct training on policies and procedures regarding health and safety. Licensee agrees to submit copies of completed trainings to CCLD by POC due date.
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9
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14
8
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14
Type A
02/26/2025
Section Cited
CCR
87468.1(a)(1)
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7
Personal Rights of Residents in All Facilities

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:

(1) To be accorded dignity in their personal relationships with staff, residents, and other persons.

Based on interviews conducted, the facility failed to ensure that R1 was properly dressed which poses an immediate health, safety or personal rights risk to persons in care.
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Licensee agrees to conduct training regarding policies, and procedures as it pertains to Personal Rights. Licensee agrees to submit copies of completed trainings to CCLD by POC due date.
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7
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7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Jacques Leffall
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 24-AS-20240926113818
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: TRUEWOOD BY MERRILL, CLOVIS
FACILITY NUMBER: 107209035
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/11/2025
Section Cited
CCR
87468.1(a)(8)
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2
3
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5
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7
Personal Rights of Residents in All Facilities

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:


(8) To have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs.

Based on interviews conducted, the facility failed to notify R1’s responsible parties of the multiple falls that occurred which poses a potential health, safety or personal rights risk to persons in care.
1
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3
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5
6
7
Licensee agrees to conduct training regarding policies, and procedures as it pertains to Personal Rights. Licensee agrees to submit copies of completed trainings to CCLD by POC due date.
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14
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Type B
03/11/2025
Section Cited
CCR
87217(b)
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7
Safeguards for Resident Cash, Personal Property, and Valuables

(b) Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff. The licensee shall give the residents receipts for all such articles or cash resources.


Based on interviews conducted, the facility could not locate R1’s bed sheets when the responsible parties requested for it which poses a potential health, safety or personal rights risk to persons in care.
1
2
3
4
5
6
7
Licensee agrees to conduct training regarding policies, and procedures as it pertains to Personal Rights. Licensee agrees to submit copies of completed trainings to CCLD by POC due date.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Jacques Leffall
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4