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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 240403819
Report Date: 03/26/2024
Date Signed: 04/05/2024 09:20:52 AM

Unsubstantiated


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
12/15/2023 and conducted by Evaluator Sarah Hurt
COMPLAINT CONTROL NUMBER: 24-AS-20231215095617
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: 72DATE:
03/26/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Program Director, Katherine Coleman TIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Resident sustained unexplained fracture while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sarah Hurt arrived at the facility unannounced on 03/26/2024 at 12:00 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 Resident sustained unexplained fracture while in care. On 12/08/2023 Kings View Work Experience staff notice bruising on Client 1’s left knee during a brief change. Client 1 also sustained a “left humoral fracture” and was put in a splint on 12/13/2023. Kings View Work Experience Staff 1 stated they are not sure how Client 1 sustained bruising on the left knee. Staff 1 stated they also changed Resident 1’s brief on 12/07/2023 and did not notice any type of bruising, and nothing happened at Kings View Work Experience that may have caused a fracture.

Continued...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024
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 2
Control Number 24-AS-20231215095617
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
VISIT DATE: 03/26/2024
NARRATIVE
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Continued..

Three separate Kings View Work Experience staff stated during interviews conducted that Client 1 did not have any falls at the facility, and they do not know how Client 1 sustained bruising on their knee. Client 1 is nonverbal and was not able to clearly communicate during interviews how the injuries on 12/08/2023, and 12/13/2023 were sustained. Client 2, and Client 3 also attend Kings View Work Experience Center are nonverbal and were not able to communicate if they witnessed any injuries Client 1 sustained. 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.

Exit interview conducted with Program Director Katherine Coleman, and a copy of this report provided.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2