547201874-3-12-2025-24-AS-KHOS-DEQULE-20250313154036

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 547201874
Report Date: 03/11/2025
Date Signed: 03/12/2025 03:50:22 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 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
04/12/2024 and conducted by Evaluator Sarah Hurt

COMPLAINT CONTROL NUMBER: 24-AS-20240412153651

FACILITY NAME:	MERZOIAN RANCH LLC.		FACILITY NUMBER:	547201874
ADMINISTRATOR:	EVANS, KIMILA		FACILITY TYPE:	740
ADDRESS:	21402 AVENUE 112		TELEPHONE:	(559) 793-1786
CITY:	PORTERVILLE	STATE: CA	ZIP CODE:	93257
CAPACITY:	6	CENSUS: 4	DATE:	03/11/2025
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Administrator, Kimila Evans		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Facility did not report client injury
Facility staff did not seek timely medical attention for client's injury

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sarah Hurt arrived at the facility unannounced on 03/11/2025 at 11:00 a.m. to deliver findings on the above allegations. LPA met with facility Administrator Kimila Evans, and explained the purpose for today’s visit.

Regarding the allegation Facility did not report client injury. Facility staff did report Resident 1's injury to Licensing on 04/13/2024. Based on records reviewed, it is undetermined whether or not the allegation occurred. 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.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025

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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Control Number 24-AS-20240412153651

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: MERZOIAN RANCH LLC.	FACILITY NUMBER: 547201874
	VISIT DATE: 03/11/2025

NARRATIVE

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Regarding the allegation Facility staff did not seek timely medical attention for client's injury. Facility staff did seek medical attention for Resident 1 on 04/12/2024. Based on records reviewed, it is undetermined whether or not the allegation occurred. 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 conducted with Facility Administrator Kimila Evans, and a copy of this report provided.

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025

LIC9099 (FAS) - (06/04)

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