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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 547203489
Report Date: 03/18/2022
Date Signed: 03/18/2022 04:17:08 PM

Unsubstantiated


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
09/28/2021 and conducted by Evaluator Kelly J. McClurg
COMPLAINT CONTROL NUMBER: 24-AS-20210928104555
FACILITY NAME:AGUILAR HOMEFACILITY NUMBER:
547203489
ADMINISTRATOR:AGUILAR, SYLVIA R.FACILITY TYPE:
735
ADDRESS:17353 ROAD 320TELEPHONE:
(559) 784-5157
CITY:SPRINGVILLESTATE: CAZIP CODE:
93265
CAPACITY:4CENSUS: 3DATE:
03/18/2022
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Administrator/Licensee Sylvia Aguilar; Licensee John Aguilar;TIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff over medicate resident;
Administrator does not afford a resident dignity and respect in their relationships;
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
An Complaint visit was conducted on the date & times indicated above by Licensing Program Analyst (LPA) K. Mcclurg. LPA met with Administrator/Licensee (A/L) Sylvia Aguilar & Licensee (L) John Aguilar LPA stated purpose of visit.

Allegations reviewed with A/L & L. Facility & resident documents reviewed.
The Department has investigated the above allegations & have found them to be unsubstantiated.

Exit interview conducted with A/L & L. Report provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Andy Xiong
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022
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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