157209103-3-23-2022-24-AS-MHON-CCV22W-20220325170124

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157209103
Report Date: 03/23/2022
Date Signed: 03/23/2022 11:56:52 AM

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
09/21/2021 and conducted by Evaluator Melinda Medina

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20210921164342

FACILITY NAME:	AAA RESIDENTIAL ELDERLY RETREAT		FACILITY NUMBER:	157209103
ADMINISTRATOR:	BELL, ALEXIS E		FACILITY TYPE:	740
ADDRESS:	4313 MONITOR STREET		TELEPHONE:	(661) 213-6798
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93307
CAPACITY:	6	CENSUS: 6	DATE:	03/23/2022
		UNANNOUNCED	TIME BEGAN:	10:42 AM
MET WITH:	Shiela Taylor		TIME COMPLETED:	12:04 PM

ALLEGATION(S):

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Facility does not safeguard resident's property
Facility does not refill resident's medication in a timely manner
Resident's care needs are not being met

INVESTIGATION FINDINGS:

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During the course of the investigation, LPA interviewed staff and reviewed records.

Staff made several attempts to contact the company that R1 reported having ordered the cellphone from however were unable to speak with anyone to verify. Staff reviewed video from the front entrance camera and no video was observed to indicate that a cellphone was delivered and/or stolen. R1’s medications were on regular delivery from the Pharmacy and R1 was receiving assistance with care needs. LPA attempted to make contact with reporting party to obtain additional information, however the telephone number provided did not belong to the RP. R1 could not be interviewed as R1 moved from the facility and left no forwarding number.

Based on interviews and records review, we have found that the above allegations were unfounded, meaning they were false, could not have happened, and/or were without reasonable basis. We have therefore dismissed the complaint.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Melinda Medina	TELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2022

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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