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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 150406456
Report Date: 10/09/2025
Date Signed: 10/09/2025 10:05:51 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
08/14/2025 and conducted by Evaluator Jimmy Duarte
COMPLAINT CONTROL NUMBER: 24-AS-20250814082708
FACILITY NAME:CENTRE VILLAGEFACILITY NUMBER:
150406456
ADMINISTRATOR:RODRIGUEZ LOPEZ, NORAFACILITY TYPE:
735
ADDRESS:2500 GOSFORD ROADTELEPHONE:
(661) 836-2500
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY:76CENSUS: DATE:
10/09/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:TIME COMPLETED:
10:15 AM
ALLEGATION(S):
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Resident fell resulting in an injury while in care.
Staff did not provide proper medical attention for resident.
INVESTIGATION FINDINGS:
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On 10/09/25, Licensing Program Analysts (LPAs) J. Duarte and M. Medina arrived unannounced to deliver findings on the above allegations. LPAs introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPAs met with Administrator, Nora Lopez.

During the course of the investigation, LPAs conducted interviews and reviewed records.

Interviews conducted with facility staff revealed that on 08/12/25, R1 lost balance resulting in R1 hitting their left eyebrow on the shower door. Additionally, on 08/12/25, facility staff observed R1 losing balance while getting out of bed resulting in R1 falling. R1 was assessed by the on-site nurse practitioner (NP) and facility staff scheduled a follow-up appointment with R1’s primary care physician(PCP). LPA reviewed records and verified that R1 was assessed by the NP after the falls and R1 was seen for a follow-up appointment with the PCP.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Jimmy Duarte
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
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-20250814082708
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: CENTRE VILLAGE
FACILITY NUMBER: 150406456
VISIT DATE: 10/09/2025
NARRATIVE
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Based on interviews conducted and records review, the allegations: Resident fell resulting in an injury while in care and Staff did not provide proper medical attention for resident are UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

No deficiencies issued.

An exit interview was conducted. A copy of this report was discussed and provided to the Administrator, Nora Lopez, whose signature on this form confirms receipt of this document.
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Jimmy Duarte
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2