107209048-10-26-2023-24-AS-SPIY-CX7RGP-20231102130103

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107209048
Report Date: 10/26/2023
Date Signed: 10/26/2023 02:19:14 PM

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
10/24/2023 and conducted by Evaluator Katie Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20231024092235

FACILITY NAME:	RIVER BLUFFS MEMORY CARE COMMUNITY		FACILITY NUMBER:	107209048
ADMINISTRATOR:	HURLEY, DONNA		FACILITY TYPE:	740
ADDRESS:	5425 W. SPRUCE AVE.		TELEPHONE:	(559) 840-9347
CITY:	FRESNO	STATE: CA	ZIP CODE:	93722
CAPACITY:	36	CENSUS: 35	DATE:	10/26/2023
		UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Donna Hurley		TIME COMPLETED:	02:34 PM

ALLEGATION(S):

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Staff are blocking the facility's exits
Staff spoke inappropriately towards a resident while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Katie Brown arrived at the facility unannounced to conduct the initial 10 - day complaint inspection. LPA met with and explained the elements of the allegations with Administrator (AD) Donna Hurley.

Immediately upon arrivial to the facility, AD and LPA toured the facility. LPA observed that passageways and emergency exits were free of obstruction. Based on observation and staff interviews, the exits were not blocked during this visit.

Interviews were conducted with 3 Care Providers who worked the day RP identified overhearing a staff member speak inappropriately to Resident (R1). The CPs interviewed deny being aware of or hearing the inappropriate conduct.

See LIC 9099-C for continuation of this report

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie Brown	TELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023

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

Control Number 24-AS-20231024092235

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: RIVER BLUFFS MEMORY CARE COMMUNITY	FACILITY NUMBER: 107209048
	VISIT DATE: 10/26/2023

NARRATIVE

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Based on observation, interview and record review of R1's file, the above allegations are UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur.

There were no citations issued

An exit interview was conducted and a copy of this report was left with AD, whose signature confirms receipt of these documents.

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie Brown	TELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
10/24/2023 and conducted by Evaluator Katie Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20231024092235

FACILITY NAME:	RIVER BLUFFS MEMORY CARE COMMUNITY		FACILITY NUMBER:	107209048
ADMINISTRATOR:	HURLEY, DONNA		FACILITY TYPE:	740
ADDRESS:	5425 W. SPRUCE AVE.		TELEPHONE:	(559) 840-9347
CITY:	FRESNO	STATE: CA	ZIP CODE:	93722
CAPACITY:	36	CENSUS: 35	DATE:	10/26/2023
		UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Donna Hurley		TIME COMPLETED:	02:34 PM

ALLEGATION(S):

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Staff do not ensure the facility's fire alarms are operating properly
Staff locked a resident in their room for an extended period of time

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Katie Brown arrived at the facility unannounced to conduct the initial 10 - day complaint inspection. LPA met with and explained the elements of the allegations with Administrator (AD) Donna Hurley.

Interview with AD revealed that on 10/19 and 10/20/23, Matson Alarm was called out to assess "chirping" smoke alarms throughout the facility resulting in the detectors being removed. The fire supression system (smoke alarms and fire sprinklers) remains in place and in working order. A detailed activity report confirming continued operation was provided. The intsallation of new smoke detectors is scheduled for 11/1/23 by Matson Alarm.

Interview and observation reveal that resident rooms cannot be locked from inside. Based on observation,

See LIC 9099-C for continuation of this report

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie Brown	TELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 24-AS-20231024092235

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: RIVER BLUFFS MEMORY CARE COMMUNITY	FACILITY NUMBER: 107209048
	VISIT DATE: 10/26/2023

NARRATIVE

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R1 ambulates independently with a walker. Record review and interview state that R1 can walk through the facility independently including in and out of the room by self.

This Agency has investigated the allegations listed above. We have found that the allegations are UNFOUNDED, therefore we have dismissed the allegations.

There were no citations issued

An exit interview was conducted and a copy of this report was left with AD, whose signature confirms receipt of these documents.

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie Brown	TELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4