157208915-7-6-2023-24-AS-MHON-CTLN5H-20230710100933

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157208915
Report Date: 07/06/2023
Date Signed: 07/06/2023 03:15:20 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
06/26/2023 and conducted by Evaluator Lisa Salazar

COMPLAINT CONTROL NUMBER: 24-AS-20230626122017

FACILITY NAME:	PALMS AT SAN LAUREN, THE		FACILITY NUMBER:	157208915
ADMINISTRATOR:	RICE, DOUGLAS		FACILITY TYPE:	740
ADDRESS:	5300 HAGEMAN RD		TELEPHONE:	(661) 218-8333
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93308
CAPACITY:	68	CENSUS: 65	DATE:	07/06/2023
		UNANNOUNCED	TIME BEGAN:	01:54 PM
MET WITH:	Administrator, Doug Rice		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

1
2
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5
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8
9

Staff do not provide the resident with water

INVESTIGATION FINDINGS:

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2
3
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5
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7
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9
10
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12
13

On 07/06/23, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to conduct the required 10-day site inspection.

LPA reviewed Hospice Care notes, interviewed Administrator and relative of Resident R1. Based on the information received, we have found that the complaint was Unfounded, meaning that the allegation is false, could not have happened and or is without reasonable basis, therefore, we have dismissed the complaint. No deficiency cited on today's visit.

Exit interview conducted. A copy of this report was provided to Administrator.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa Salazar	TELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

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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