247209172-5-6-2025-24-AS-SPIY-DGFS8Q-20250507133930

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 247209172
Report Date: 05/06/2025
Date Signed: 05/06/2025 01:48:04 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 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
04/10/2025 and conducted by Evaluator Rachel A Bruce

COMPLAINT CONTROL NUMBER: 24-AS-20250410151052

FACILITY NAME:	VALLEY SPRING MEMORY CARE		FACILITY NUMBER:	247209172
ADMINISTRATOR:	REYNAGA, ELIZABETH		FACILITY TYPE:	740
ADDRESS:	555 MILLER LANE		TELEPHONE:	(209) 710-4783
CITY:	LOS BANOS	STATE: CA	ZIP CODE:	93635
CAPACITY:	50	CENSUS: 29	DATE:	05/06/2025
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Elizabeth Reynaga, Administrator		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff did not provide an authorized representative access to a resident's records

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) R Bruce conducted an unannounced complaint investigation visit for the purpose of delivering the finding for the above allegation. LPA Bruce met with Administrator Elizabeth Reynaga.

During the course of this investigation LPA reviewed facility files relevant to the complaint investigation, as well as conducting interviews. It was determined that the above allegation: Staff not providing medical records to a resident representative is UNFOUNDED. Resident R1's spouse indicated that records have been provided. Administration verified that to be true. This agency has investigated the complaint and found it be UNFOUNDED meaning that the allegation was false, could not have happened or is without a reasonable basis. The complaint has been dismissed.

An exit interview was conducted a copy of the report provided to the administrator.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Rachel A Bruce	TELEPHONE: (559) 470-9001
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025

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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