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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157208853
Report Date: 04/27/2023
Date Signed: 04/27/2023 11:41:39 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
01/23/2023 and conducted by Evaluator Alexandria Walton
COMPLAINT CONTROL NUMBER: 24-AS-20230123112948
FACILITY NAME:STREBOR HOMEFACILITY NUMBER:
157208853
ADMINISTRATOR:SAYSON, SHANNONFACILITY TYPE:
735
ADDRESS:15730 STREBOR DRIVETELEPHONE:
(661) 695-9278
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY:4CENSUS: 4DATE:
04/27/2023
UNANNOUNCEDTIME BEGAN:
10:19 AM
MET WITH:Administrator, Shannon SaysonTIME COMPLETED:
11:55 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff did not provide adequate food service to resident
Facility operated out of ratio
Facility staff did not follow resident's care plan
Facility staff did not safeguard resident's money
Facility staff yells at residents
Facility staff do not treat all residents with dignity
Resident's room is malodorous
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 04/27/2023, Licensing Program Analyst (LPA) Walton arrived unannounced to deliver findings on the above allegations. LPA introduced self, stated the purpose of the visit and requesetd to meet with the Administrator. LPA met with Administrator, Shannon Sayson

During today's visit, LPA conducted staff interviews.

LPA conducted a facility tour and observed an adequate food supply. Residents eat meals at the dining table and staff will bring meals to R1 in R1's room. Residents are given 3 meals and 2 snacks each day. Residents rooms were observed and appeared to be clean and odor free during the inspection.

Upon review of financial records LPA found that the receipts accounted for current balance for all residents in care. CONTINUED TO 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023
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-20230123112948
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: STREBOR HOME
FACILITY NUMBER: 157208853
VISIT DATE: 04/27/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Review of records revealed that facility staff take residents out of the facility individually. It was determined that S2 transports R2 to various food trucks and restaurants for individual outings.

Consistent statements from staff revealed that staff have not yelled at residents in care and have not denied food to residents in care. LPA reviewed records and observed an updated IPP for all residents in care.

Interviews with the Administrator revealed that the facility is staffed with 2-3 staff per shift. LPA reviewed the facility schedule and confirmed that there are approximately 2-3 staff per shift.

Based on record review and interviews conducted, the allegations: Facility staff did not provide adequate food service to resident, Facility operated out of ratio, Facility staff did not follow resident's care plan, Facility staff did not safeguard resident's money, Facility staff yells at residents, Facility staff do not treat all residents with dignity, and Resident's room is malodorous are found to be 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. Exit interview conducted. A copy of this report was discussed and provided to Administrator, Shannon Sayson, whose signature on this form confirms receipt of this document.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2