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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 167202502
Report Date: 06/04/2020
Date Signed: 06/04/2020 03:57:01 PM



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
04/30/2020 and conducted by Evaluator See Moua
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20200430150912
FACILITY NAME:HANNA'S HOME CAREFACILITY NUMBER:
167202502
ADMINISTRATOR:FELLEKE, HANNAFACILITY TYPE:
740
ADDRESS:2427 CHERRYWOOD CT.TELEPHONE:
(559) 583-6880
CITY:HANFORDSTATE: CAZIP CODE:
93230
CAPACITY:6CENSUS: 4DATE:
06/04/2020
UNANNOUNCEDTIME BEGAN:
03:27 PM
MET WITH:Hanna Felleke, Administrator TIME COMPLETED:
03:28 PM
ALLEGATION(S):
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9
Resident sustained a fracture while in care
INVESTIGATION FINDINGS:
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5
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13
Licensing Program Analyst (LPA) S. Moua called and spoke with Administrator Hanna Felleke regarding the complaint allegation. Findings were delivered over the phone due to COVID 19 precaution guidelines.

Facility staff and resident were interviewed. Staff denied that resident was handled in a way that resulted in resident sustaining a fracture while in care. Records reviewed documents that resident has osteoporosis and is fragile. Hospital discharge report was also reviewed and there was no mention of the arm fracture or what follow-up order is needed. It is difficult to determine exactly when and how the fracture occurred. Resident also denied being in pain related to the fracture and refused to wear the sling provided to her. There is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is Unsubstantiated. Exit interview was conducted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Brenda WhiteTELEPHONE: (559) 650-7908
LICENSING EVALUATOR NAME: See MouaTELEPHONE: (559) 580-6596
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2020
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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