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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107209360
Report Date: 12/19/2024
Date Signed: 12/19/2024 12:46:31 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
11/08/2024 and conducted by Evaluator Alexandria Walton
COMPLAINT CONTROL NUMBER: 24-AS-20241108113724
FACILITY NAME:NORTHWEST VILLAFACILITY NUMBER:
107209360
ADMINISTRATOR:ROYCHOUDHURY, MINAKSHIFACILITY TYPE:
740
ADDRESS:542 W. BROWNING AVENUETELEPHONE:
(559) 448-8964
CITY:FRESNOSTATE: CAZIP CODE:
93704
CAPACITY:6CENSUS: 6DATE:
12/19/2024
UNANNOUNCEDTIME BEGAN:
11:53 AM
MET WITH:Administrator, Minakshi RoychoudhuryTIME COMPLETED:
12:02 PM
ALLEGATION(S):
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Staff did not address inappropriate interaction between residents in care
Staff did not seek medical attention for residents in a timely manner
Staff do not maintain a comfortable temperature in the home
Staff do not provide adequate food service
Administrator does not spend a sufficient amount of time managing the daily operations of the facility
Facility is in disrepair
INVESTIGATION FINDINGS:
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On 12/19/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to deliver findings on the above allegations. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Administrator, Minakshi Roychoudhury.

During the course of the investigation, LPA conducted interviews, reviewed records and conducted a facility tour. During the tour, LPA observed the facility to be clean, at comfortable temperature and in good repair. LPA observed an adequate food supply. Record review and interviews revealed that staff seek medical attention for residents. Interviews revealed that the Administrator spends a sufficient amount of time to managing the facility.

Based on observation, interviews, and records review, the allegations: Staff did not address inappropriate interaction between residents in care; Staff did not seek medical attention for residents in a timely manner; Staff do not maintain a comfortable temperature in the home; Staff do not provide adequate food service; Administrator does not spend a sufficient amount of time managing the daily operations of the facility; Facility is in disrepair are UNSUBSTANTIATED. CONTINUED TO 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
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 2
Control Number 24-AS-20241108113724
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: NORTHWEST VILLA
FACILITY NUMBER: 107209360
VISIT DATE: 12/19/2024
NARRATIVE
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Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

No deficiencies issued. Exit interview conducted. A copy of this report was discussed and provided to Administrator, Minakshi Roychoudhury, whose signature confirms receipt of this document.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2