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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157206907
Report Date: 12/10/2024
Date Signed: 12/10/2024 08:44:42 PM

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
12/05/2024 and conducted by Evaluator Rachel A Bruce
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20241205110220
FACILITY NAME:UNION VILLAFACILITY NUMBER:
157206907
ADMINISTRATOR:MONTIANO, NANCYFACILITY TYPE:
735
ADDRESS:1102 S. UNION AVE.TELEPHONE:
(661) 323-0768
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY:89CENSUS: 56DATE:
12/10/2024
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Nancy Montiano, Administrator TIME COMPLETED:
02:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained unexplained burn.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/10/2024, Licensing Program Analyst (LPA) R. Bruce arrived at the facility for an unannounced visit relating to the above allegation. LPA met with Administrator Nancy Montiano and explained the purpose of the visit and reviewed the elements of the allegation. LPA delivered the following complaint investigation finding.
The Department investigated the allegation listed above. Based on interviews conducted and records reviewed the resident has a history of making false allegations, due to her documented mental health issues. In this case the resident (alleged victim) was not able to provide factual information and her accounting of the incident was not cohesive and did not make sense. Resident refused medical treatment and at the time of the interview, there was no physical evidence of a burn. The alleged perpetrator (roommate) was interviewed and was also not able to provide adequate information to investigate beyond denying involvement.
Based on observation and interview of staff and residents, the above allegation is UNSUBSTANTIATED.
Although the allegation may have happened or may be valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Rachel A Bruce
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024
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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