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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 547203972
Report Date: 05/08/2024
Date Signed: 05/08/2024 12:42:25 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
02/05/2024 and conducted by Evaluator Katie Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20240205160913
FACILITY NAME:CENTRAL VALLEY TRAINING CENTERFACILITY NUMBER:
547203972
ADMINISTRATOR:LOWES, MARIAFACILITY TYPE:
775
ADDRESS:9838 W. GROVE AVETELEPHONE:
(559) 651-2844
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY:75CENSUS: 36DATE:
05/08/2024
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Maria LowesTIME COMPLETED:
01:12 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not provide adequate supervision resulting in resident sustaining a fracture due to a fall
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Katie Brown arrived unannounced to deliver investigation findings. LPA met with and explained the reason for the visit with Program Director (PD) Maria Lowes

Interviews reveal that Client (C1) has a history of falls and unsteady gait while ambulating at home and Day Program (DP). C1 fell at DP on 1/29/24. According to the 2 staff present at the time of the fall, C1 got up independently and did not verbalize pain or limping. C2 stated C1 fell that day at DP and at home. C1 was taken to urgent care on 1/30/24 and diagnosed with a fracture. It cannot be determined that the fracture occurred at the day program. Based on interview and record review the above allegations are UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur.

There were no citations issued. An exit interview was conducted and a copy of this report was left with PD, whose signature confirms receipt of this report.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Katie Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024
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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