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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157202769
Report Date: 01/25/2024
Date Signed: 01/26/2024 08:51:06 AM

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
12/27/2023 and conducted by Evaluator Melinda Medina
COMPLAINT CONTROL NUMBER: 24-AS-20231227094002
FACILITY NAME:CARRINGTON OF SHAFTERFACILITY NUMBER:
157202769
ADMINISTRATOR:ALICIA WEBBFACILITY TYPE:
740
ADDRESS:250 EAST TULARE AVENUETELEPHONE:
(661) 746-6521
CITY:SHAFTERSTATE: CAZIP CODE:
93263
CAPACITY:64CENSUS: 44DATE:
01/25/2024
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Alicia WebbTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff hit resident
Staff do not ensure resident receives a sufficient quantity of food
Staff spit in resident’s food
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 1/25/24, Licensing Program Analyst (LPA) M. Medina conducted a subsequent visit to gather information, conduct interviews and deliver findings on this complaint. LPA met with Administrator, Alicia Webb and stated purpose of visit.

Based on review of records and interviews conducted, the allegations of staff hit resident, staff do not ensure resident receives a sufficient quantity of food, and staff spit in resident's food are UNSUBSTANTIATED. During interviews and review of records, there was not sufficient information to show that client was left unsupervised for alleged incident to occur.

No deficiencies cited. Exit interview conducted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024
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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