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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208933
Report Date: 02/20/2025
Date Signed: 02/20/2025 03:19:02 PM

Document Has Been Signed on 02/20/2025 03:19 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:NEMIA HOMEFACILITY NUMBER:
157208933
ADMINISTRATOR/
DIRECTOR:		GO, CELESTEFACILITY TYPE:
734
ADDRESS:3256 JENKINS RDTELEPHONE:
(650) 238-4987
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY: 5CENSUS: 5DATE:
02/20/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Celeste GoTIME VISIT/
INSPECTION COMPLETED:
03:35 PM
NARRATIVE
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On 2/20/25, Licensing Program Analyst (LPA) Daiquiri Boyd arrived unannounced at the above facility to conduct a Case Management-Deficiency visit. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator Celeste Go.

On 12/30/2024, the Fresno CCL office was notified that on 12/23/2024, a staff witnessed another 1:1 Direct Service Staff slap a client on the thigh while changing a colostomy bag. The staff that witnessed the incident phoned the Administrator to report what she had seen. Resident is non-verbal. Facility Administrator stated that they placed the staff S1 in question on Administrative Leave while they are investigating. Staff monitored the resident and noticed no adverse reactions.

Deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6.

Exit interview conducted and a plan of correction was reviewed and developed and cleared. A copy of this report and appeal rights were discussed and provided to Administrator, Celeste Go, whose signature on this form confirms receipt of this document.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Daiquiri Boyd
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/20/2025 03:19 PM - It Cannot Be Edited


Created By: Daiquiri Boyd On 02/20/2025 at 02:32 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: NEMIA HOME
FACILITY NUMBER: 157208933

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/21/2025
Section Cited
CCR
80072(a)(3)

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80072(a)(3) Personal Rights- (a)...each client shall have personal rights which include, but are not limited to, the following: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature,...
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Facility Administrator stated that Caregiver Burnout, Mandated Reporting on Suspected Abuse and Client Dignity, Person Centered Approach, Positive Behavior Supports, Behavior Intervention Plans, CPI training was provided to all staff. Training was provided by their
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 this requirement was not met as evidenced by: staff S1 was seen slapping a client on the thigh while preforming daily hygeine tasks, which poses an immediate health and safety risk to residents/clients in care.
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Behavior Specialist on 12/24/24, 12/27/24 and a follow-up was done on 1/07/2025. The attendance was documented through ZOOM online class. The staff S1 is still on Administrative leave and no determination as to the return of S1 has been made. The deficiency has been cleared at this time.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Sergiy Pidgirny
LICENSING EVALUATOR NAME:Daiquiri Boyd
LICENSING EVALUATOR SIGNATURE:
DATE: 02/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2025


LIC809 (FAS) - (06/04)
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