157209196-6-13-2024-24-AS-SPIY-D6DK78-20240619073840

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157209196
Report Date: 06/13/2024
Date Signed: 06/13/2024 02:45:35 PM

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
03/14/2024 and conducted by Evaluator Shawna Doucette

COMPLAINT CONTROL NUMBER: 24-AS-20240314113726

FACILITY NAME:	TAR SPRINGS HOME CARE		FACILITY NUMBER:	157209196
ADMINISTRATOR:	TELMO, SOCORRO ANN		FACILITY TYPE:	740
ADDRESS:	2804 TAR SPRINGS AVENUE		TELEPHONE:	(661) 831-3430
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93313
CAPACITY:	6	CENSUS:	DATE:	06/13/2024
		UNANNOUNCED	TIME BEGAN:	11:08 AM
MET WITH:	Administrator Socorro Telmo		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Due to abuse, resident received an injury

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Shawna Doucette arrived at the facility unannounced to commence a complaint investigation and deliver findings. LPA identified herself and explained the purpose of the visit with Staff Beatriz Ancheta. Administrator Socorro Telmo responded to the facility to assist with the visit.

LPA reviewed records and interviewed staff.

Based on interviews, LPA was unable to determine whether or not R1, received a bruise due to abuse. Based on Hospice records review, R1 bruises easily due to a medication R1 is currently taking.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

A copy of this report was provided to Administrator via email.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna Doucette	TELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024

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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