107209048-4-18-2022-24-AS-SPIY-CDPTTV-20220421150120

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107209048
Report Date: 04/18/2022
Date Signed: 04/18/2022 12:15:40 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
11/15/2021 and conducted by Evaluator Katie Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20211115085326

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:	04/18/2022
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Donna Hurley		TIME COMPLETED:	12:20 PM

ALLEGATION(S):

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Facility was unable to conduct a timely assessment in order for resident to be discharged from hospital.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Katie Brown arrived unannounced at the facility to deliver investigation findings. LPA met with and explained the purpose of the visit with Administrator Donna Hurley.

The Department investigated the allegation: Facility was unable to conduct a timely assessment in order for resident to be discharged from hospital. The Department conducted multiple interviews resulting in conflicting information. Based on interviews and record review of the hospital Clinical Notes, the hospital was in communication with the facility administration and R1’s Responsible Party multiple times to plan the discharge of R1. Based on interview and record review, the allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur.

A copy of this report was provided and an exit interview was conducted with Donna Hurley.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Katie Brown	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2022

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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