547208809-3-11-2022-24-AS-MHON-CCYLPH-20220329085559

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 547208809
Report Date: 03/11/2022
Date Signed: 03/11/2022 02:32:38 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
01/10/2022 and conducted by Evaluator Mai Yang

COMPLAINT CONTROL NUMBER: 24-AS-20220110160058

FACILITY NAME:	PARK VISALIA ASSISTED LIVING		FACILITY NUMBER:	547208809
ADMINISTRATOR:	MARTIN VALE		FACILITY TYPE:	740
ADDRESS:	3939 WEST WALNUT AVENUE		TELEPHONE:	(559) 625-3388
CITY:	VISALIA	STATE: CA	ZIP CODE:	93277
CAPACITY:	110	CENSUS: 61	DATE:	03/11/2022
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Administrator Martin Vale		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Resident sustained scratches while in care as the result of rough handling by staff

INVESTIGATION FINDINGS:

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On 3/11/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct complaint investigation visit and deliver complaint finding on the above allegation. LPA introduced self, stated the purpose of the visit, and met with Administrator Martin Vale.

During the course of the investigation, interviews were conduct with staffs and resident. Base on the staffs and resident’s interviews, the allegation resident sustained scratches while in care as the result of rough handling by staff, is UNFOUNDED, meaning they were false, could not have happened, and/or are without reasonable basis. We have therefore dismissed the complaint.

Exit interview conducted. As a COVID-19 precautionary measure, a copy of this report will be provided via email. Report signed on-site.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR NAME: Mai Yang	TELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022

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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