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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 547208243
Report Date: 08/04/2023
Date Signed: 08/04/2023 02:01:53 PM

Substantiated


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
05/31/2023 and conducted by Evaluator Melinda Medina
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20230531092050
FACILITY NAME:ENCLAVE AT THE FOOTHILLSFACILITY NUMBER:
547208243
ADMINISTRATOR:HERNANDEZ, JAVIERFACILITY TYPE:
735
ADDRESS:10650 ROAD 256TELEPHONE:
(559) 527-5091
CITY:TERRA BELLASTATE: CAZIP CODE:
93270
CAPACITY:100CENSUS: 14DATE:
08/04/2023
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Laura Li, Chief Administrative OfficerTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Facility did not report incidents to licensing
INVESTIGATION FINDINGS:
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On 8/04/23, Licensing Program Analyst (LPA) M. Medina and Licensing Program Manager (LPM) M. Hoffmann conducted a subsequent visit to deliver findings to complaint. LPA and LPM met with Laura Li, Chief Administrative Officer.

During the investigation, LPA conducted interviews and reviewed records and based on review, the allegation that facility does not follow reporting requirements is SUBSTANTIATED. Facility did not submit incident reports within 7 days for an incident involving R1 that occurred on 5/2/23. It was not submitted until 5/13/23; Incidents involving R2 occurred on 5/29 however an incident report was not submitted until 6/13/23. An incident involving R3 occurred on 6/1/23 however an incident report was not submitted until 6/13/23. This poses a potential risk to the health, safety, or personal rights of residents in care.

Deficiency cited in the attached 9099D for violation of Title 22, Division 6, Chapter 1, Article 06. Appeal rights provided, and exit interview conducted with Chief Administrative Officer.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023
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
Control Number 24-AS-20230531092050
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: ENCLAVE AT THE FOOTHILLS
FACILITY NUMBER: 547208243
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
08/18/2023
Section Cited
CCR
80061
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Reporting Requirements (b)…In addition, a written report containing the information specified in (2) below shall be submitted to the licensing agency within seven days following the occurrence of such event. (E) any
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Facility will submit written plan to Fresno Regional Office by POC outlining how reporting requirements will be submitted within 7 days of occurrence of incident.
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unusual incident or client absence which threatens the physical or emotional health or safety of any client.

This requirement was not met when facility did not submit reports within 7 days for incidents occurring on 5/2/23 involving R1, 5/29/23 involving R2, and 6/1/23 involving R3.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
05/31/2023 and conducted by Evaluator Melinda Medina
COMPLAINT CONTROL NUMBER: 24-AS-20230531092050

FACILITY NAME:ENCLAVE AT THE FOOTHILLSFACILITY NUMBER:
547208243
ADMINISTRATOR:HERNANDEZ, JAVIERFACILITY TYPE:
735
ADDRESS:10650 ROAD 256TELEPHONE:
(559) 527-5091
CITY:TERRA BELLASTATE: CAZIP CODE:
93270
CAPACITY:100CENSUS: 14DATE:
08/04/2023
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Laura Li, Chief Administrative OfficerTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
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8
9
Uncleared adult in the facility
INVESTIGATION FINDINGS:
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11
12
13
On 8/04/23, Licensing Program Analyst (LPA) M. Medina and Licensing Program Manager (LPM) M. Hoffmann conducted a subsequent visit to deliver findings to complaint. LPA and LPM met with Laura Li, Chief Administrative Officer.

The Department investigated the complaint that there is an uncleared adult residing at facility and based on records review and interview, R4 was not in violation of parole requirements. Although the allegation may be true or valid, there is not a preponderance of evidence to prove or disprove the allegation occurred therefore the complaint is UNSUBSTANTIATED.

No deficiencies cited. Exit interview conducted with Chief Administrative Officer.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3