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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 247209026
Report Date: 02/07/2022
Date Signed: 02/07/2022 11:29:55 AM

Unsubstantiated


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
01/11/2022 and conducted by Evaluator Alexandria Walton
COMPLAINT CONTROL NUMBER: 24-AS-20220111133129
FACILITY NAME:LLC RETIREMENT HOMES IIFACILITY NUMBER:
247209026
ADMINISTRATOR:LAMERSON, LINDSEYFACILITY TYPE:
740
ADDRESS:1944 FAXON DRTELEPHONE:
(209) 761-2478
CITY:ATWATERSTATE: CAZIP CODE:
95301
CAPACITY:6CENSUS: 6DATE:
02/07/2022
UNANNOUNCEDTIME BEGAN:
10:46 AM
MET WITH:Caregiver, Estella MendozaTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Facility denied authorized representative entry into the facility
INVESTIGATION FINDINGS:
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On 02/07/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to deliver findings on the above allegation. LPA introduced self, stated the purpose of the visit and reqeusted to meet with the Administrator. Administrator was not present upon LPAs arrival, LPA contacted Administrator via telephone. Administrator gave verbal permission to meet with Caregiver. LPA met with Caregiver, Estella Mendoza.

On 01/10/2022, Administrator was notified that LPAs, Ombudsman, Hospice nurses, Physical Therapist, and Occupational Therapists are exempt from testing for COVID-19 on site, providing test results and/or providing documentation of proof of vaccination prior to entry as they are considered essential visitors. On the same date, Administrator updated facility policies to reflect the new information.

CONTINUED TO LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2022
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-20220111133129
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: LLC RETIREMENT HOMES II
FACILITY NUMBER: 247209026
VISIT DATE: 02/07/2022
NARRATIVE
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Based on interviews conducted and review of records, the allegation: Facility denied authorized representative entry into the facility is UNSUBSTANTIATED. 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.

No deficiencies issued during this inspection.

Exit interview conducted. A copy of this report will be provided via email as a COVID-19 precautionary measure. Report signed on site by Facility Representative.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2