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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157209417
Report Date: 08/04/2026
Date Signed: 08/04/2026 12:34:50 PM

Substantiated


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
04/08/2026 and conducted by Evaluator Jimmy Duarte
COMPLAINT CONTROL NUMBER: 24-AS-20260408103446
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: DATE:
08/04/2026
UNANNOUNCEDTIME BEGAN:
12:16 PM
MET WITH:Licensee Benjamin DonelTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Staff falsified medication records.
INVESTIGATION FINDINGS:
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On 08/04/2026, Licensing Program Analyst (LPA) J. Duarte and Licensing Program Analyst A. Walton met with Licensee Benjamin Donel and delivered findings.

During the course of investigation, LPA reviewed medication for R1. LPA reviewed the acetaminophen medication for the afternoon and four out of the five pills in the bubble pack should have been dispensed. The MARs was signed to show medication was administered; however, the medication remained in the bubble pack. Staff did not have documentation to indicate or state a reason why the medication was not dispensed to R1. The MARs for R1 also indicated that on 04/06/2026, R1 refused medication with reason being that R1 was asleep. Staff interviews revealed R1 was asleep during the medication pass and staff did not want to wake up R1, so a refusal was indicated in the MARs log. However, per the administrator, the facility policy is to attempt to wake up residents and make three attempts to administer medication if a resident refuses medication

Based on interviews and documentation, the preponderance of evidence standard has been met; therefore, the allegation is SUBSTANTIATED.

A deficiency is being cited in accordance with California Code of Regulations, Title 22, Division 6, chapter 8, on the attached 9099D.

An exit interview was conducted. A copy of this report was discussed and provided Licensee Benjamin Donel, whose signature on this form confirms receipt of this document. A plan of correction was developed and a copy of this report and appeal rights were provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexandria Walton
LICENSING EVALUATOR NAME: Jimmy Duarte
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2026
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-20260408103446
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/19/2026
Section Cited
CCR
87465(a)(4)
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87465 Incidental Medical and Dental Care
(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:
(4) The licensee shall assist residents with self-administered medications as needed
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Licensee agrees to review section 87465 and train staff on the requirements of section 87465. Licensee will submit a copy of training topics and attendance to the Fresno CCL office by the POC due date.
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This requirement was no met as evidenced by: LPA reviewed the acetaminophen medication for the afternoon and four out of the five pills in the bubble pack should have been dispensed. The MARs was signed to show medication was administered; however, the medication remained in the bubble pack. Staff did not have documentation to indicate or state a reason why the medication was not dispensed to R1. The MARs for R1 also indicated that on 04/06/2026, R1 refused medication reason being is that R1 was asleep. Staff interviews revealed R1 was asleep during the medication pass and staff did not want to wake up R1, so a refusal was indicated in the MARs log, which poses a potential health and safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Alexandria Walton
LICENSING EVALUATOR NAME: Jimmy Duarte
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2