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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 240403819
Report Date: 02/20/2024
Date Signed: 03/04/2024 01:51:25 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 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
08/16/2023 and conducted by Evaluator Sarah Hurt
COMPLAINT CONTROL NUMBER: 24-AS-20230816145449
FACILITY NAME:KINGS VIEW WORK EXPERIENCE CENTERFACILITY NUMBER:
240403819
ADMINISTRATOR:KALEMBER, SAMUELFACILITY TYPE:
775
ADDRESS:100 AIRPARK ROADTELEPHONE:
(209) 357-0321
CITY:ATWATERSTATE: CAZIP CODE:
95301
CAPACITY:200CENSUS: 84DATE:
02/20/2024
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH: Program Director, Katherine ColemanTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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9
Staff did not seek timely medical care for resident in care
Staff did not follow proper reporting requirements
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Sarah Hurt arrived at the facility unannounced on 02/20/2024 at 02:00 p.m. to deliver findings on the above allegations. LPA met with facility Program Director, Katherine Coleman and explained the purpose for today’s visit.

Regarding the allegation Staff did not seek timely medical care for resident in care. Client 1 had several falls at the facility on 08/09/2023 resulting in a fractured femur. Facility staff present did not examine Client 1 for physical signs of injury, resulting in delayed medical care. Based on LPAs interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED

Regarding the allegation Staff did not follow proper reporting requirements. Facility staff did not contact Responsible Party for Client 1 on 08/09/2023 to inform them of Client 1's falls at the facility . Based on LPAs interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED

The following deficincies are being cited Per Title 22 Regulations.

Exit interview conducted with Program Director, Katherine Coleman, and a copy of this report along with appeals rights provided.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2024
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 3
Control Number 24-AS-20230816145449
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: KINGS VIEW WORK EXPERIENCE CENTER
FACILITY NUMBER: 240403819
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/21/2024
Section Cited
CCR
82075(a)(f)
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82075 Health-Related Services (a) The licensee shall ensure that each client receives necessary first aid and other needed medical or dental services, including arrangement for and/or provision of transportation to the nearest available services. The following requirement has not been met as evidenced by:
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Program Director will conduct training for all staff on timely medical care, and procedures for client falls/injuries, and send proof to LPA by POC date of 02/21/2024.
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Client 1 fell at the facility resulting in a fractured femur. Facility staff did not complete a physical examination of Client 1 to determine if medical care was needed, resulting in delayed medical care, which poses an immediate health, safety, or personal rights risk to clients in care.
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Type B
03/06/2024
Section Cited
CCR
82068(a)(f)
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82068 Admission Agreements (a) The licensee shall complete and maintain an individual written admission agreement with each client and the client's authorized representative, if any.
(f) The licensee shall comply with all terms and conditions set forth in the admission agreement. The following requirement has not been met as evidenced by:
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Facility Program Director will conduct training with facility staff on incident reporting, and send proof to LPA by POC date of 03/06/2024.
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Facility staff did not contact Client 1's Responsible party on 08/09/2023 to inform of falls sustained by Client 1 at the facility which poses a potential health, safety, or personal rights risk to residents 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.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 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
08/16/2023 and conducted by Evaluator Sarah Hurt
COMPLAINT CONTROL NUMBER: 24-AS-20230816145449

FACILITY NAME:KINGS VIEW WORK EXPERIENCE CENTERFACILITY NUMBER:
240403819
ADMINISTRATOR:KALEMBER, SAMUELFACILITY TYPE:
775
ADDRESS:100 AIRPARK ROADTELEPHONE:
(209) 357-0321
CITY:ATWATERSTATE: CAZIP CODE:
95301
CAPACITY:200CENSUS: 84DATE:
02/20/2024
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH: Program Director, Katherine ColemanTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Client's diapering needs are not properly met by staff
INVESTIGATION FINDINGS:
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3
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5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Sarah Hurt arrived at the facility unannounced on 02/20/2024 at 02:00 p.m. to deliver findings on the above allegations. LPA met with facility Program Director, Katherine Coleman and explained the purpose for today’s visit.

Regarding the allegation Client's diapering needs are not properly met by staff. Responsible party for Client 1 requested the facility staff prompt Client 1 to use the bathroom during the day as they do at home. Facility Staff 1 stated they do prompt Client 1 to use the restroom every 2 hours during the day while at the facility. Client 1's Physicians Report, and Needs and Services plan do not document Client 1's need for incontinent care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

No deficincies are being cited Per Title 22 Regulations.

Exit interview conducted with Program Director, Katherine Coleman, and a copy of this report along with appeals rights provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3