<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 547202796
Report Date: 11/07/2023
Date Signed: 11/07/2023 09:11:36 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 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
10/10/2023 and conducted by Evaluator Miriam Flores
COMPLAINT CONTROL NUMBER: 24-AS-20231010105659
FACILITY NAME:LEE'S COUNTRY HOMEFACILITY NUMBER:
547202796
ADMINISTRATOR:LEE, ELIZABETHFACILITY TYPE:
735
ADDRESS:11282 AVENUE 272TELEPHONE:
(559) 308-1294
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:4CENSUS: 2DATE:
11/07/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Elizabeth LeeTIME COMPLETED:
09:20 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff overmedicated resident while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst, M. Flores arrived unannounced at the facility to deliver investigation findings. LPA explained the reason for the visit and delivered the investigation findings to Licensee, Elizabeth Lee.

The Department investigated the following allegation: Staff overmedicated resident while in care.

Based on file reviews and interviews conducted for R1, the allegation listed above is UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur; therefore, the allegation is unsubstantiated. Exit interview was conducted with Licensee Elizabeth Lee, a copy of this report was provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Miriam Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3