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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 02:56:07 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
07/24/2023 and conducted by Evaluator Melinda Medina
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20230724172025
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:
02:05 PM
MET WITH:Laura Li, Chief Administrative OfficerTIME COMPLETED:
03:10 PM
ALLEGATION(S):
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Staff are not adequately supervising residents in care.
Staff are not ensuring a safe environment for residents in care.
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. The allegations that staff are not adequately supervising residents in care and staff are not ensuring a safe environment for residents in care are SUBSTANTIATED. R1 and R2 have been allowed to leave the facility unsupervised although their medical assessments indicate that it should be with accompaniment or staff assistance. Additionally, on 7/11/23, at approximately 8:00 PM, a neighbor observed R1 collect dry brush outside the facility and place it against a door and set it on fire, at which time they called 911.
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-20230724172025
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
VISIT DATE: 08/04/2023
NARRATIVE
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Facility staff were unaware of the fire until the fire department arrived, and they went outside. R1 was arrested for felony arson and is currently in custody pending hearing, with no bail. R1’s medical assessment indicates that R1 is allowed to leave the facility with accompaniment due to significant history of AWOL (Absence Without Official Leave). Although R1 was technically on facility grounds when the fire occurred, the building where R1 set the fire is unoccupied at this time and required that R1 exit the occupied area of facility and walk around to the unoccupied area. Staff did not provide adequate supervision to R1 resulting in not ensuring a safe environment for 15 of 15 residents in care at time of fire. This posed an immediate risk to the health, safety, or personal rights of residents in care.

Deficiencies cited in the attached 9099D for violation of Division 6, Chapter 1, Article 06., Section 80078. Appeal rights provided, and exit interview conducted with Chief Administrative Officer.
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
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 24-AS-20230724172025
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 A
08/05/2023
Section Cited
CCR
80078
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Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the client's needs.

**This was not met when R1 and R2
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Facility will provide a written plan to Fresno Regional Office to ensure how care and supervision requirements by POC due date.
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were allowed to leave the facility unsupervised though their medical assessments require that they be accompanied or have staff assistance. Additionally, on 7/11/23, staff did not provide care and supervision as necessary to meet the needs of R1. This posed an immediate risk to the health, safety, or personal rights of residents in care.
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Request Denied
Type A
08/05/2023
Section Cited
CCR
80072
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Personal Rights (a)(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
**This requirement was not met
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Facility will provide a written plan to Fresno Regional Office to ensure how care and supervision requirements by POC due date.
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when on 7/11/23, staff did not ensure the safety of residents in care when R1 started a fire at the facility.
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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: 3 of 3