160403371-12-21-2022-24-AS-MHON-CMCSXQ-20221222131616

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 160403371
Report Date: 12/21/2022
Date Signed: 12/21/2022 10:53:36 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/21/2022 and conducted by Evaluator Alexandria Walton

COMPLAINT CONTROL NUMBER: 24-AS-20221121165132

FACILITY NAME:	MARGIE'S HOME FOR THE AGED		FACILITY NUMBER:	160403371
ADMINISTRATOR:	JAUREZ, MARGARET		FACILITY TYPE:	740
ADDRESS:	313 E. MALONE		TELEPHONE:	(559) 583-6936
CITY:	HANFORD	STATE: CA	ZIP CODE:	93230
CAPACITY:	5	CENSUS: 2	DATE:	12/21/2022
		UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Administrator, Margaret Juarez		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Facility staff left multiple residents unsupervised

INVESTIGATION FINDINGS:

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On 12/21/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to deliver findings on the above allegation. LPA introduced self, stated the purpose of the visit, and reqeusted to meet with the Administrator. LPA met with Administrator, Margaret Juarez.

During today's investigation, LPA conducted resident interviews.

Based on interviews conducted, the allegation: Facility staff left multiple residents unsupervised is UNSUBSTANTIATED. Although the allegation could have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

No deficencies issued. A copy of this report was discussed and provided to Administrator, Margaret Juarez, whose signature on this form confirms receipt of this document.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Alexandria Walton	TELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022

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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