547206600-12-4-2023-24-AS-SMOA-CYWNDT-20231227092251

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 547206600
Report Date: 12/04/2023
Date Signed: 12/04/2023 01:57:44 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 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
09/08/2023 and conducted by Evaluator Kamaldeep Kaur

COMPLAINT CONTROL NUMBER: 24-AS-20230908103937

FACILITY NAME:	WALNUT GROVE HOUSE, INC. DBA LEWIS GRAVES ARF #1		FACILITY NUMBER:	547206600
ADMINISTRATOR:	GARCIA, BRIANNA		FACILITY TYPE:	735
ADDRESS:	25401 ROAD 152		TELEPHONE:	(559) 747-3319
CITY:	VISALIA	STATE: CA	ZIP CODE:	93277
CAPACITY:	6	CENSUS: 4	DATE:	12/04/2023
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Staff Lisa Gonzalez		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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9

Staff are not providing a client with sufficient food

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) K. Kaur arrived at the facility for a subsequent visit. LPA met with Staff Lisa Gonzalez and explained the purpose of the visit and reviewed the elements of the allegations. LPA delivered the following complaint investigation findings.

The Department investigated the allegations listed above. Based on interviews conducted and records reviewed; Resident (R1) was instructed by health care provider to have smaller meals trough out the day to avoid digestion problems that were caused with a bigger meals.

Based on observation and interview of staff and residents, the above allegations are 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 these allegations are unsubstantiated.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023

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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