540405657-2-14-2022-24-AS-SPIY-CBRQ3D-20220218104831

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 540405657
Report Date: 02/03/2022
Date Signed: 02/14/2022 10:21:47 AM

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
02/18/2021 and conducted by Evaluator Mary Garza

COMPLAINT CONTROL NUMBER: 24-AS-20210218112424

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: 30	DATE:	02/03/2022
		UNANNOUNCED	TIME BEGAN:	05:00 PM
MET WITH:	Administrator, Lisa Silveira		TIME COMPLETED:	05:44 PM

ALLEGATION(S):

1
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8
9

Staff did not notify resident's hospice nurse of change in resident's medical condition

INVESTIGATION FINDINGS:

1
2
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13

On 2/3/2022 Licensing Program Analyst M. Garza completed a complaint visit for the above allegations. Due to COVID precautionary measures the visit was completed via tele-conference. LPA explained reason for video call and tour the facility with Administrator. LPA observed residents in rooms.

During the course of the investigation LPA conducted interviews and reviewed records (Personnel Report, staff schedule, hospice guidelines and current PIN's. LPA requested hospice records). Interviews revealed R1 was not receiving hospice services while at the facility. Due to R1 not being on hospice during this time the facility was not obligated to provide an update to hospice because hospice was not initiated with R1.

Based on interviews and record reviews, the allegation above is UNFOUNDED.

Exit interview conducted. A copy of this report provided via email. A delivered and read receipt serves as confirmation.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Mary Garza	TELEPHONE: (559) 365-9009
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022

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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