157209599-5-9-2026-24-AS-SMOA-DTZPH9-20260512111930

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157209599
Report Date: 05/09/2026
Date Signed: 05/09/2026 11:05:05 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
04/28/2026 and conducted by Evaluator Melinda Medina

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20260428093736

FACILITY NAME:	CARRINGTON OF SHAFTER		FACILITY NUMBER:	157209599
ADMINISTRATOR:	JAIME, AMANDA N		FACILITY TYPE:	740
ADDRESS:	250 E TULARE AVE		TELEPHONE:	(661) 746-6521
CITY:	SHAFTER	STATE: CA	ZIP CODE:	93263
CAPACITY:	98	CENSUS: 48	DATE:	05/09/2026
		UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Amanda Jaime		TIME COMPLETED:	11:20 AM

ALLEGATION(S):

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Staff did not provide resident with adequate supervision, resulting in an injury

INVESTIGATION FINDINGS:

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On 5/09/2026, Licensing Program Analyst (LPA) M. Medina conducted a subsequent complaint visit to return R1's file and deliver findings to complaint. LPA contacted Administrator, Amanda Jaime by telephone to conduct visit with LPA. .

During complaint visit, LPA toured facility, conducted interviews, gathered documentation, and obtained video footage. The information obtained during interviews states that Resident 1 (R1) was placed in the front room of facility without supervision, fell, and obtained injury. The front room of facility where R1 was sitting, has windows around perimeter allowing observation from reception, entry way, and hallways. R1 did have a fall, however, during review of footage from camera it was observed that 5 staff responded to R1 within 15 seconds of fall to provide care for R1.

Although the allegation may have happened, there is not a preponderance of evidence to prove that the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED.

No deficiencies cited during complaint visit.

Exit interview conducted with Administrator and copy of report this report was provided for facility records.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2026

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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