157209299-1-31-2024-24-AS-SMOA-D26PFC-20240205101632

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157209299
Report Date: 01/31/2024
Date Signed: 01/31/2024 11:09:25 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 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
12/26/2023 and conducted by Evaluator Mai Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20231226102403

FACILITY NAME:	LERWICK HOME CARE		FACILITY NUMBER:	157209299
ADMINISTRATOR:	TELMO, SOCORRO ANN		FACILITY TYPE:	740
ADDRESS:	10213 LERWICK AVENUE		TELEPHONE:	(661) 665-2874
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93311
CAPACITY:	6	CENSUS: 5	DATE:	01/31/2024
		UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Administrator Socorro Ann Telmo		TIME COMPLETED:	11:02 AM

ALLEGATION(S):

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alleged physical abuse

INVESTIGATION FINDINGS:

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On 01/31/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to deliver findings on the above allegation. LPA introduced self, stated the purpose of the visit, and requested to meet with Administrator. LPA met with caregiver Reynald Ignacio. Administrator Socorro Ann Telmo was called and arrived shortly.

During the course of the investigation, interviews were conducted, and records were reviewed. Allegation of alleged physical abuse, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the above allegation is UNSUBSTANTIATED. Exit interview was conducted. A copy of this report was provided to Administrator, whose signature confirms receipt of this report.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: See Moua	TELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai Yang	TELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

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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