<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157206743
Report Date: 07/15/2024
Date Signed: 07/15/2024 04:18:53 PM

Unfounded


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
04/19/2024 and conducted by Evaluator Melinda Medina
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20240419142051
FACILITY NAME:ARCADIA GARDENS RESIDENTIAL CARE IIFACILITY NUMBER:
157206743
ADMINISTRATOR:SOCORRO ANN, TELMOFACILITY TYPE:
740
ADDRESS:10813 DELICATO CTTELEPHONE:
(661) 410-8022
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:6CENSUS: 5DATE:
07/15/2024
UNANNOUNCEDTIME BEGAN:
03:07 PM
MET WITH:Socorro Ann TelmoTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Questionable Death
Staff did not provide resident’s medication as prescribed
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 7/15/24, Licensing Program Analysts (LPAs) M. Medina and L. Salazar conducted an unannounced subsequent complaint visit to deliver findings. LPA introduced self and stated purpose of visit. LPAs met with Administrato, Socorro Ann Telmo to deliver findings.

This Department investigated the allegation of questionable death and staff did not provide residents's medication as prescribed for R1. Per record review and information gathered during interviews, LPA observed R1's cause of death to be noted as natural causes. LPA also observed record of physician order to discontinue medication for R1.

This Department has found that the above allegations are UNFOUNDED, meaning they were false, could not have happened, and/or were without reasonable basis. We have therefore dismissed the complaint.

No deficiencies cited.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024
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 4
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
04/19/2024 and conducted by Evaluator Melinda Medina
COMPLAINT CONTROL NUMBER: 24-AS-20240419142051

FACILITY NAME:ARCADIA GARDENS RESIDENTIAL CARE IIFACILITY NUMBER:
157206743
ADMINISTRATOR:SOCORRO ANN, TELMOFACILITY TYPE:
740
ADDRESS:10813 DELICATO CTTELEPHONE:
(661) 410-8022
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:6CENSUS: 5DATE:
07/15/2024
UNANNOUNCEDTIME BEGAN:
03:07 PM
MET WITH:Socorro Ann TelmoTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not seek medical care for resident
Staff did not notify authorized representatives of an unusual incident
Licensee did not issue a refund to the resident's authorized representative
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 7/15/24, Licensing Program Analysts (LPAs) M. Medina and L. Salazar conducted an unannounced subsequent complaint visit to deliver findings. LPA introduced self and stated purpose of visit. LPAs met with Administrato, Socorro Ann Telmo to deliver findings.

This Department investigated the above allegations. During interviews and review of facility records, it was discovered that staff did not contact 911 after R1's fall, notify authorized representative of an unusual incident or issue a refund to the resident's authorized representative.

The preponderance of evidence standard has been met; therefore, the above allegation is found to be Substantiated. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 24-AS-20240419142051
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: ARCADIA GARDENS RESIDENTIAL CARE II
FACILITY NUMBER: 157206743
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/26/2024
Section Cited
CCR
87465(g)
1
2
3
4
5
6
7
The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical
1
2
3
4
5
6
7
Administrator to submit written plan to Fresno Regional Office to outline facility procedures to ensure that this regulation is met in the future.
8
9
10
11
12
13
14
crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4).
**This was not met as evidenced by, staff called Hospice when R1 fell they did not call 911.
8
9
10
11
12
13
14
Type B
07/26/2024
Section Cited
CCR
87468.1(a)(8)
1
2
3
4
5
6
7
(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (8)To have their representatives regularly informed by the licensee of activities related to care or services, including
1
2
3
4
5
6
7
Administrator to submit written plan to Fresno Regional Office to outline facility procedures to ensure that this regulation is met in the future.
8
9
10
11
12
13
14
ongoing evaluations, as appropriate to their needs. **This was not met as evidenced by Staff did not notify authorized representatives of R1's fall.

8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 24-AS-20240419142051
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: ARCADIA GARDENS RESIDENTIAL CARE II
FACILITY NUMBER: 157206743
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/15/2024
Section Cited
HSC
1659.652(c)
1
2
3
4
5
6
7
c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually
1
2
3
4
5
6
7
Administrator issued refund to authorized representative on 4/22/24 by cashier's check.

DEFICIENCY CLEARED AT TIME OF COMPLAINT VISIT.
8
9
10
11
12
13
14
responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed.**This was not met as evidenced LPAs interview with Administrator/Licensee
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4