547200844-1-15-2021-24-AS-MHON-BXGV7X-20210121151149

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 547200844
Report Date: 01/13/2021
Date Signed: 01/15/2021 02:44:02 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
12/07/2020 and conducted by Evaluator Dixie Marie Wright

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20201207084941

FACILITY NAME:	PRESTIGE ASSISTED LIVING AT VISALIA		FACILITY NUMBER:	547200844
ADMINISTRATOR:	SHELLHAMER, DAVID		FACILITY TYPE:	740
ADDRESS:	3120 W. CALDWELL		TELEPHONE:	(559) 735-0828
CITY:	VISALIA	STATE: CA	ZIP CODE:	93277
CAPACITY:	72	CENSUS: 43	DATE:	01/13/2021
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	David Shellhamer		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff do not keep facility in good repair.

INVESTIGATION FINDINGS:

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On this date, LPA D. Wright spoke with Administrator David Shellhamer via telephone due to COVID-19 and precautionary measures.

Based on interviews and review of documents, this allegation is unfounded. LPA did not find that staff do not keep facility in good repair. LPA determined Administrator followed proper protocol to make necessary repairs, and LPA did not find that repairs were neglected; repairs were made as timely as possible.

David was advised that the above allegations are unfounded, and therefore we have dismissed the allegations.
A copy of this report was provided to David via email and an electronic email read receipt confirms receiving these documents.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Dixie Marie Wright	TELEPHONE: (559) 772-7402
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2021

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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