547200264-7-29-2021-24-AS-MHON-C66MEB-20210823093229

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 547200264
Report Date: 07/29/2021
Date Signed: 07/29/2021 12:17:43 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
05/04/2021 and conducted by Evaluator Melinda Medina

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20210504134317

FACILITY NAME:	RIVERSEDGE ELDERCARE		FACILITY NUMBER:	547200264
ADMINISTRATOR:	PRESTAGE, MARY ELLEN		FACILITY TYPE:	740
ADDRESS:	285 SOUTH WESTWOOD		TELEPHONE:	(559) 788-0611
CITY:	PORTERVILLE	STATE: CA	ZIP CODE:	93257
CAPACITY:	6	CENSUS: 0	DATE:	07/29/2021
		UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Mary Ellen Prestage		TIME COMPLETED:	10:37 AM

ALLEGATION(S):

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Facility staff mismanages medications.

INVESTIGATION FINDINGS:

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Licensing Program Manager (LPM) M. Hoffmann and Licensing Program Analyst (LPA) M. Medina conducted a subsequent complaint visit on this date. LPA met with Licensee, Mary Ellen Prestage and stated purpose of visit.

LPA Medina conducted subsequent facility tour on this date. Based on the information gathered during the complaint investigation, interviews conducted and review of medication and medication records there is no evidence to prove or disprove that medications were mismanaged by facility staff.

This complaint allegations is UNSUBSTANTIATED

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Melinda Medina	TELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021

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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