547208809-7-30-2021-24-AS-SPIY-C5KLUM-20210804090410

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 547208809
Report Date: 07/26/2021
Date Signed: 07/30/2021 01:53:53 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
03/19/2021 and conducted by Evaluator Katie Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20210319135011

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:	DATE:	07/26/2021
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Cynthia Galvan		TIME COMPLETED:	02:50 PM

ALLEGATION(S):

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Resident is being mistreated by another resident while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Katie Brown conducted the subsequent complaint investigation visit to the facility to obtain additional information. LPA met with Cynthia Galvan, Resident Care Director.

During the course of this visit LPA reviewed facility Narrative Charting Notes, Physicians Reports, Outside Agency Documentation and Needs and Services Plans for R1 and R1. LPA also interviewed S1 and S2.

The Department has investigated the allegation that a resident was mistreated by another resident while in care. Based on Record Review and Interview, it was found that when R1 and R2 were roommates, they had episodes of verbal altercations. There was no evidence provided or reported to show that one resident harmed another. On 3/18/21 before R1 returned from a hospital stay, R2 was moved to a different room. Both R1 and R2 are in their own rooms. The allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Katie Brown	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021

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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