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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 247204141
Report Date: 10/04/2023
Date Signed: 10/04/2023 08:18:03 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
08/29/2023 and conducted by Evaluator Sarah Hurt
COMPLAINT CONTROL NUMBER: 24-AS-20230829114452
FACILITY NAME:C AND D'S GUEST HOME #6FACILITY NUMBER:
247204141
ADMINISTRATOR:DOBBINS, CHANTEFACILITY TYPE:
735
ADDRESS:6314 ATWATER JORDAN RDTELEPHONE:
(209) 357-5195
CITY:ATWATERSTATE: CAZIP CODE:
95301
CAPACITY:6CENSUS: 4DATE:
10/04/2023
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Facility staff, Sandra Barros TIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff unlawfully evicted a resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit to the facility to deliver investigation findings. LPA’ met with Sandra Barros and explained the purpose of today’s visit.

Regarding the allegation staff unlawfully evicted a resident. Facility staff was aware Resident 1 needed 24 hour care. Resident 1 was taken to live with a roomate who was not able to provide the care needed. Based on interviews conducted,and records reviewed during this investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED at this time.

The following Deficiencies are being cited Per Title 22 Regulations.

Exit interview conducted with Facility staff Sandra Barros, and a copy of this report provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023
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-20230829114452
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: C AND D'S GUEST HOME #6
FACILITY NUMBER: 247204141
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/04/2023
Section Cited
CCR
85068.5
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85068.5 Eviction Procedures (a) The licensee shall be permitted to evict a client by serving the client with a 30-day written notice to quit for any of the following reasons:
The following requirement has not been met as evidenced by:
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Licensee will conduct trainng with Administrators on legal eviction procedures and submit proof to LPA Hurt by POC date of 10/05/2023.
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Resident 1 was taken to live with a roomate who could not provide care needed which poses an immediate, health, safery, 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: 10/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2