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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157209207
Report Date: 04/09/2024
Date Signed: 04/10/2024 08:57:29 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 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
01/09/2024 and conducted by Evaluator Lissett Padgett
COMPLAINT CONTROL NUMBER: 24-AS-20240109144027
FACILITY NAME:YOUR LOVED ONES MATTER LLCFACILITY NUMBER:
157209207
ADMINISTRATOR:JIMENEZ, ISAIFACILITY TYPE:
740
ADDRESS:4804 KENNY STTELEPHONE:
(661) 491-3782
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY:6CENSUS: DATE:
04/09/2024
UNANNOUNCEDTIME BEGAN:
02:26 PM
MET WITH:Guadalupe Jimenez, Care GiverTIME COMPLETED:
02:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff illegally evicted resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) L.Padgett conducted an unannounced facility visit to deliver findings on the allegations listed above. Licensee was not able to meet with LPA and authorized care giver, Guadalupe Jimenez to sign this document. LPA reviewed finding with Licensee over the phone.

During the course of this investigation LPA reviewed facility files relevant to the complaint investigation. It was determined that the above allegation: Staff illegally evicted resident is UNFOUNDED. Resident R1 AWOL’d from this facility. Licensee did not issue an eviction notice to R1 and R1 was accepted back to the facility. This agency has investigated the complaint alleging Staff illegally evicted resident. We have found that the complaint was unfounded, therefore we have dismissed the complaint.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Lissett PadgettTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024
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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