247209172-5-6-2025-24-AS-SPIY-DGFVNR-20250507163535

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 247209172
Report Date: 05/06/2025
Date Signed: 05/06/2025 02:56:39 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
02/14/2025 and conducted by Evaluator Rachel A Bruce

COMPLAINT CONTROL NUMBER: 24-AS-20250214165004

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:	DATE:	05/06/2025
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:			TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff do not ensure resident does not physically assualt other residents
Due to lack of supervisoin, resident physically assalts other residents

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 allegations. 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 allegations: Staff not providing supervision resulting in physical assaults and staff not ensureing that residents do not physically assualt each other are both found to be UNFOUNDED. Staff respond appropriately to incdents between residents. Due to memory/dementia issues it is unpredictable when resdient's may act out but it is not due to lack of supervision. Based on the investigation it has been determined the allegations are UNFOUNDED meaning that the allegations were false, could not have happened or are without a reasonable basis. The complaint has therefore sbeen 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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