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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 247209172
Report Date: 06/17/2025
Date Signed: 06/17/2025 12:47:39 PM

Substantiated


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
06/09/2025 and conducted by Evaluator Rachel A Bruce
COMPLAINT CONTROL NUMBER: 24-AS-20250609122031
FACILITY NAME:VALLEY SPRING MEMORY CAREFACILITY NUMBER:
247209172
ADMINISTRATOR:REYNAGA, ELIZABETHFACILITY TYPE:
740
ADDRESS:555 MILLER LANETELEPHONE:
(209) 710-4783
CITY:LOS BANOSSTATE: CAZIP CODE:
93635
CAPACITY:50CENSUS: 27DATE:
06/17/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Elizabeth Reynaga, Administrator TIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff spoke inappropriately to resident in care
INVESTIGATION FINDINGS:
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On 6/17/2025, Licensing Program Analyst (LPA) R Bruce conducted an unannounced visit to investigate and deliver findings on this complaint. LPA met with Elizabeth Reynaga Administrator (AD) and Natalie Levario, Resident Care Director. LPA conducted interviews and reviewed records.

The allegation was regarding a staff member (S1) using inappropriate language in front of/ and or directed towards the resident. There were witnesses to the incident, and the staff member in question admitted to swearing. LPA reviewed records and conducted interviews during the investigation. Based on the above information, the preponderance of evidence standard has been met. The allegation is SUBSTANTIATED.

Deficiency cited on the attached 9099 D
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Rachel A BruceTELEPHONE: (559) 470-9001
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
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 3
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
06/09/2025 and conducted by Evaluator Rachel A Bruce
COMPLAINT CONTROL NUMBER: 24-AS-20250609122031

FACILITY NAME:VALLEY SPRING MEMORY CAREFACILITY NUMBER:
247209172
ADMINISTRATOR:REYNAGA, ELIZABETHFACILITY TYPE:
740
ADDRESS:555 MILLER LANETELEPHONE:
(209) 710-4783
CITY:LOS BANOSSTATE: CAZIP CODE:
93635
CAPACITY:50CENSUS: 27DATE:
06/17/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Elizabeth Reynaga, Administrator TIME COMPLETED:
01:00 PM
ALLEGATION(S):
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9
Staff handled resident in care in a rough manner
INVESTIGATION FINDINGS:
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On June 17, 2025 Licensing Program Analyst (LPA) met with Administrator (AD) Elizabeth Reynaga and Natalie Levario , Resident Care Director (RCD) to deliver the finding regarding the above allegation.

The allegation of staff handling a resident in a rough manner was regarding an incident which occurred while staff was providing a shower to a resident. It was alleged that the staff member (S1) caused bruising when holding the Resident (R1's) arm.
LPA conducted an investigation including R1's medical record, and interviews of staff and ombudsman. Based on the investigation it was determined that 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 was conducted and a copy of this report LIC9099 was provided to Administrator (AD) Elizabeth Reynaga.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Rachel A BruceTELEPHONE: (559) 470-9001
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 24-AS-20250609122031
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: VALLEY SPRING MEMORY CARE
FACILITY NUMBER: 247209172
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/17/2025
Section Cited
CCR
87468.1(a)(1)
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87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by:
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Facility has provided retraining to S1 and placed her on probation. Training included resident rights, abuse prevention, proper care of dementia, behavioral expectations and professional standards.
POC to be cleared at today's visit.
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Licensee did not ensure residents were spoken to appropriately. After conducting interviews it was determined that S1 spoke inappropriately to residents in care which poses an immediate health safety and 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.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Rachel A BruceTELEPHONE: (559) 470-9001
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3