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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 547208809
Report Date: 03/07/2022
Date Signed: 03/09/2022 01:46:59 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
04/09/2021 and conducted by Evaluator Kelly J. McClurg
COMPLAINT CONTROL NUMBER: 24-AS-20210409102750
FACILITY NAME:CAREFIELD AT PARK VISALIAFACILITY NUMBER:
547208809
ADMINISTRATOR:KING, PATRICIAFACILITY TYPE:
740
ADDRESS:3939 WEST WALNUT AVENUETELEPHONE:
(559) 625-3388
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:110CENSUS: 62DATE:
03/07/2022
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Executive Director Martin Vale; TIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff did not adequately supervise resident.
Resident was found covered in urine and feces.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
An unannouced Complaint visit was conducted by Licensing Program Analyst (LPA) K. Mcclurg. LPA met with Executive Director (ED) Martin Vale. LPA stated purpose of visit.

The Department has investigated the above allegations. Based on availble information, it could not be determined that there was a lack of care & supervision of Resdient 1 (R1), therefore the allegations are unsubstanitated.

Exit interview conducted with ED. Report provided.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: Kelly J. McClurgTELEPHONE: (559) 246-0435
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2022
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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