157202769-10-24-2022-24-AS-SMOA-CLALAC-20221118073454

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157202769
Report Date: 10/24/2022
Date Signed: 10/24/2022 01:35:16 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 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
07/21/2022 and conducted by Evaluator Mary Garza

COMPLAINT CONTROL NUMBER: 24-AS-20220721123503

FACILITY NAME:	CARRINGTON OF SHAFTER		FACILITY NUMBER:	157202769
ADMINISTRATOR:	ALICIA WEBB		FACILITY TYPE:	740
ADDRESS:	250 EAST TULARE AVENUE		TELEPHONE:	(661) 746-6521
CITY:	SHAFTER	STATE: CA	ZIP CODE:	93263
CAPACITY:	64	CENSUS: 45	DATE:	10/24/2022
		UNANNOUNCED	TIME BEGAN:	11:13 AM
MET WITH:	Director, Alicia Webb		TIME COMPLETED:	01:44 PM

ALLEGATION(S):

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Staff did not keep the facility free from rodents

INVESTIGATION FINDINGS:

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On 10/24/22 Licensing Program Analyst (LPA) M. Garza arrived at facility unannounced to deliver findings on the allegations listed above. LPA introduced self, was COVID pre-screened and permitted entry into the facility. LPA met with Director, Alicia Webb and explained reason for visit. LPA completed a tour of the facility and completed a health and safety check on residents in care. Residents observed in common areas and in rooms.

During investigation LPA completed interviews, obtained records (resident roster, staff roster w/contact information, pest control receipts for May-July 2022, June/July kitchen schedule, kitchen cleaning schedule, maintenance log for May-July). 2 of 3 staff interviews indicated there was a rodent problem in the facility. Staff indicated when they noticed the issue it was reported. Pest control was then called for maintenence. LPA reviewed pest control records. Records indicated the facility has monthly pest control. Based on LPA’s interviews and records reviewed, although the allegation may of may not have occurred the preponderance of evidence standard has not been met. Therefore, the above allegation is found to be UNSUBSTANTIATED. No deficiency cited during today’s visit. Exit interview completed with Director, Alicia Webb. A copy of this report was provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: See Moua	TELEPHONE: (559) -580-4596
LICENSING EVALUATOR NAME: Mary Garza	TELEPHONE: 559-365-9009
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2022

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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