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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107209303
Report Date: 10/31/2024
Date Signed: 10/31/2024 08:30:09 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
10/23/2024 and conducted by Evaluator Martin Vega
COMPLAINT CONTROL NUMBER: 24-AS-20241023083350
FACILITY NAME:PSALMS 23 LOVING CARE RESIDENTIAL IIIFACILITY NUMBER:
107209303
ADMINISTRATOR:COOLEY, I'ISHAFACILITY TYPE:
735
ADDRESS:441 W ALLUVIAL AVETELEPHONE:
(559) 270-3822
CITY:PINEDALESTATE: CAZIP CODE:
93650
CAPACITY:4CENSUS: 2DATE:
10/31/2024
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Staff 1TIME COMPLETED:
09:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff does not ensure medications are secured and inaccessible to clients in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/31/2024 LPA M Vega conducted an initial 10-day investigation to open the complaint. Arrived unannounced to facility.
LPA met with (Staff 1) S1 and stated the purpose of the visit. S1 contacted administrator, administrator was not able to attend, however gave permission for staff to sign report.

LPA Upon entry saw that room where medication is stored was locked. S1 unlocked the door to the medications room in preparation to assist resients in providing their medication.

Based on observations and staff interview during facility visit on 10/31/24, the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Martin Vega
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2024
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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