540405657-5-1-2020-24-AS-MHON-BPAKNG-20200504080308

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 540405657
Report Date: 05/01/2020
Date Signed: 05/01/2020 02:30:34 PM

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
04/27/2020 and conducted by Evaluator Dixie Marie Wright

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20200427134034

FACILITY NAME:	CASA GRANDE SENIOR CARE HOME #2		FACILITY NUMBER:	540405657
ADMINISTRATOR:	SILVEIRA, JOE & MARIA		FACILITY TYPE:	740
ADDRESS:	417 E. WALNUT AVE		TELEPHONE:	(559) 733-0233
CITY:	VISALIA	STATE: CA	ZIP CODE:	93277
CAPACITY:	46	CENSUS:	DATE:	05/01/2020
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Joe Silveira via telephone		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Resident sustained a fracture while in care due lack of supervison
Resident was not given a proper assessment prior to admission
Staff is unlawfully evicting resident

INVESTIGATION FINDINGS:

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LPA spoke with Co-Administrator Joe Silveira to notify of investigation findings.

Based on interviews and review of documents, these allegations are unfounded. The facility was in the process of conducting a pre-admission assessment when the individual had a fall. Family was present at the facility when the fall took place and the individual was transported to the hospital. An admission agreement had not yet been signed. Per the assessment, it was decided that the individual would not be admitted to the facility. Facility was unable to conduct an assessment at the hospital due to COVID-19. Based on the individual never being admitted, the above allegations are unfounded.
A copy of this report was provided to Administrator Joe Silveira via email and an electronic email read receipt confirms receiving these documents.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda White	TELEPHONE: (559) 650-7908
LICENSING EVALUATOR NAME: Dixie Marie Wright	TELEPHONE: (559) 772-7402
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2020

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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