157209207-4-10-2024-24-AS-SPIY-D49SJX-20240412135550

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157209207
Report Date: 04/09/2024
Date Signed: 04/10/2024 10:49:00 AM

Unsubstantiated

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

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20240109144027

FACILITY NAME:	YOUR LOVED ONES MATTER LLC		FACILITY NUMBER:	157209207
ADMINISTRATOR:	JIMENEZ, ISAI		FACILITY TYPE:	740
ADDRESS:	4804 KENNY ST		TELEPHONE:	(661) 491-3782
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93307
CAPACITY:	6	CENSUS: 6	DATE:	04/09/2024
		UNANNOUNCED	TIME BEGAN:	02:32 PM
MET WITH:	Guadalupe Jimenez, Care Giver		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Staff did not accept resident back after hospital stay

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) L.Padgett conducted an unannounced facility visit to deliver findings on the allegations listed above. LPA spoke with Licensee on the phone and reviewed findings. Licensee was not able to meet with LPA but authorized care giver, Guadalupe Jimenez to sign this document.

Licensing Program Analyst (LPA) L. Padgett conducted the complaint investigation visit to the facility. During this visit LPA delivered investigation findings regarding the above allegations. The Department has investigated the complaint alleging: Staff did not accept resident back after hospital stay. Based on the interviews conducted and/or records review the above allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.
Appeal rights provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Lissett Padgett	TELEPHONE: (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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