547208809-6-23-2021-24-AS-SPIY-C4NTV3-20210706150316

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 547208809
Report Date: 06/23/2021
Date Signed: 06/23/2021 12:58:07 PM

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
01/11/2021 and conducted by Evaluator Shawna Doucette

COMPLAINT CONTROL NUMBER: 24-AS-20210111082857

FACILITY NAME:	CAREFIELD AT PARK VISALIA		FACILITY NUMBER:	547208809
ADMINISTRATOR:	KING, PATRICIA		FACILITY TYPE:	740
ADDRESS:	3939 WEST WALNUT AVENUE		TELEPHONE:	(559) 625-3388
CITY:	VISALIA	STATE: CA	ZIP CODE:	93277
CAPACITY:	110	CENSUS: 57	DATE:	06/23/2021
		UNANNOUNCED	TIME BEGAN:	11:37 AM
MET WITH:	Administrator Martin Vale		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Resident sustained severe dehydration while in care resulting in hospitalization

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Shawna Doucette contacted the facility to commence a complaint investigation to deliver findings. LPA identified herself and discussed the purpose of the visits and the elements of the allegations with Administrator Martin Vale.

The Department has investigated the allegations that Resident sustained severe dehydration while in care resulting in hospitalization. Based on interviews conducted and record/medical review(s), the Department concluded that the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are UNSUBTANTIATED.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Shawna Doucette	TELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021

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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