107209048-9-24-2024-24-AS-SPIY-D9UKVC-20241008081406

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107209048
Report Date: 09/24/2024
Date Signed: 09/24/2024 03:52:22 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
07/17/2024 and conducted by Evaluator Katie Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20240717095726

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: 34	DATE:	09/24/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Alexis Martin		TIME COMPLETED:	02:05 PM

ALLEGATION(S):

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Facility staff did not seek timely medical attention for resident who ingested incorrect medication

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct a subsequent complaint visit and deliver investigation Findings. LPA met with Welness Director, Alexis Martin.

This Department investigated the allegation: Facility staff did not seek timely medical attention for resident who ingested incorrect medication. Interviews reveal that the staff are not aware of a medication error or emergency where a resident needed medical attention. The facility did not submit a Special Incident Report to CCL reporting an incident. The Reporting Party did not identify the resident who ingested the wrong medication, therefore a medication audit and file review could not be conducted.

Based on interview and record review 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 violations did or did not occur.

There were no citations issued. An exit interview was conducted and a copy of this report was signed and left with Alexis Martin.

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: 09/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024

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 3

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
07/17/2024 and conducted by Evaluator Katie Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20240717095726

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: 34	DATE:	09/24/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Alexis Martin		TIME COMPLETED:	02:05 PM

ALLEGATION(S):

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Licensee does not ensure staff are adequately trained.
Facility staff are unable to communicate with residents.
Licensee does not ensure facility is adequately staffed to meet resident's toileting needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct a subsequent complaint visit and deliver investigation Findings. LPA met with Wellness Director, Alexis Martin.

This Department investigated the allegation: Licensee does not ensure staff are adequately trained. Record reviews for current staff including Care Providers and Med Techs were conducted. The files reviewed contained record of required initial and annual training.

This Department investigated the allegation: Facility staff are unable to communicate with residents. Based on interviews conducted and observation, many residents are hard of hearing. Some staff interviewed acknowledge having an accent and needing to speak louder and/or slower for residents. This is the same for residents with hearing loss.

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: 09/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024

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 3

Control Number 24-AS-20240717095726

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: 09/24/2024

NARRATIVE

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This Department investigated the allegation: Licensee does not ensure facility is adequately staffed to meet resident's toileting needs. The facility was toured 7/25/24 and 9/24/24. Residents were observed throughout the common areas and in rooms dressed, appearing clean with no odors. Staff interviews did not reveal concern about staff meeting resident needs. Resident care plans note each residents assistance level for toileting and other ADLs. The staffing schedule was reviewed for July 2024.

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 signed and left with Alexis Martin.

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie Brown	TELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024

LIC9099 (FAS) - (06/04)

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