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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157209417
Report Date: 09/11/2025
Date Signed: 09/11/2025 01:51:07 PM

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
09/05/2025 and conducted by Evaluator Jimmy Duarte
COMPLAINT CONTROL NUMBER: 24-AS-20250905110736
FACILITY NAME:REAL CARE LLCFACILITY NUMBER:
157209417
ADMINISTRATOR:PELAYA, JESSICAFACILITY TYPE:
740
ADDRESS:818 REAL RDTELEPHONE:
(661) 760-7610
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY:300CENSUS: 23DATE:
09/11/2025
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Jessica PelayaTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff did not re order residents medications timely.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) J. Duarte and S. Doucette conducted a visit to commence a complaint investigation. LPAs identified themselves and discussed the purpose of the visit, the elements of the allegations and delivered findings with Administrator (AD), Jessica Pelaya.

LPAs reviewed and obtained copies of the Centrally Stored Medication, MARS, medication in Memory Care for R1 and R2. LPAs requested R2's hospice records; however, facility did not have records of R2's hospice care.

Based on interviews with AD, R1 did not have a seizure. LPAs did not locate an IR or any documentation indicating R1 had a seizure. Based on records review and MARs log, medication was administered as prescribed. However, facility did not have a centrally stored medication log for R1 and R2 for August 2025. LPAs were unable to determine if medications for R1 and R2 were ordered in a timely manner.
Continued on LIC 9099C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Jimmy Duarte
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 24-AS-20250905110736
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: REAL CARE LLC
FACILITY NUMBER: 157209417
VISIT DATE: 09/11/2025
NARRATIVE
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Continued from LIC 9099.

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 AD Jessica Pelaya.
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Jimmy Duarte
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2