167208806-1-27-2023-24-AS-SMOA-CNNLKB-20230202074915

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 167208806
Report Date: 01/27/2023
Date Signed: 01/27/2023 04:56:19 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 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
11/28/2022 and conducted by Evaluator Mary Garza

COMPLAINT CONTROL NUMBER: 24-AS-20221128163630

FACILITY NAME:	CHESTER CARE HOME 2		FACILITY NUMBER:	167208806
ADMINISTRATOR:	CHESTER, FLORAY		FACILITY TYPE:	735
ADDRESS:	1558 PEACHWOOD STREET		TELEPHONE:	(559) 362-5674
CITY:	LEMOORE	STATE: CA	ZIP CODE:	93245
CAPACITY:	6	CENSUS: 4	DATE:	01/27/2023
		UNANNOUNCED	TIME BEGAN:	04:36 PM
MET WITH:	Administrator, Floray Chester		TIME COMPLETED:	05:02 PM

ALLEGATION(S):

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Resident was pushed by facility personnel resulting in bruises

INVESTIGATION FINDINGS:

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On 1/27/2023 Licensing Program Analyst (LPA) M. Garza arrived at facility to complete an unannounced visit to deliver complaint findings. LPA met with Direct Care Staff, Shanita Richmond and Aministrator, Floray Chester was called. Administrator arrived a short time later. LPA was permitted entry to facility. LPA was temperature checked but was not COVID pre-screened with questions at entry. LPA completed a Health and Safety check on residents in care. Residents observed in dining area at time of visit.

During investigation interviews were completed and records requested and reviewed by IB. Per the police report, resident denied facility staff pushing them resulting in bruises. Although the allegation may or may not have happened, it does not meet the preponderance of evidence standard per Title 22. The allegation is UNSUBSTANTIATED.

Exit interview completed. A copy of this report was given to Administrator, Floray Chester.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

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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