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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 547208849
Report Date: 06/15/2020
Date Signed: 06/15/2020 04:33:21 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
10/17/2019 and conducted by Evaluator Kelly J. McClurg
COMPLAINT CONTROL NUMBER: 24-AS-20191017115608
FACILITY NAME:GLORY DAYS ASSISTED LIVING INCFACILITY NUMBER:
547208849
ADMINISTRATOR:AGUILAR, MELINDAFACILITY TYPE:
740
ADDRESS:1303 S. PINKAM STTELEPHONE:
(559) 625-1452
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY:10CENSUS: 5DATE:
06/15/2020
UNANNOUNCEDTIME BEGAN:
07:15 AM
MET WITH:Administrator Melinda AguilarTIME COMPLETED:
10:15 AM
ALLEGATION(S):
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9
Staff caused a resident to sustain a fracture.
INVESTIGATION FINDINGS:
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13
An unannounced Complaint call was conducted on the date & during the times indicated above by Licensing Program Analyst (LPA) K. Mcclurg. LPA spoke with Administrator Melinda Aguilar.

Administrator (Admin) & staff interviewed. Facility incident reports, Staff 2 (S2) statement, & Resident 1 (R1) records including hospice & hospital records reviewed. According to interviews & records available at the time of investigation, on 7/14/19 R1 lost balance & (S2) assisted R1 with preventing fall. At that time S2 assessed R1 & no signs of injury were indicated &/or observed. On 7/15/19 R1 indicated pain in arm, was sent to hospital & returned to facility same day with diagnosis of arm fracture. Hospice provided care for fracture. No additional information available at this time to indicate that S2 caused arm fracture to R1.

The Department has investigated the above allegation. Although the above allegation may have happened, there is no evidence at this time to prove that a violation occurred, therefore the allegation is unsubstantiated.

Exit interview conducted with Administrator Melinda Aguilar. 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: 06/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2020
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 2
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
10/17/2019 and conducted by Evaluator Kelly J. McClurg
COMPLAINT CONTROL NUMBER: 24-AS-20191017115608

FACILITY NAME:GLORY DAYS ASSISTED LIVING INCFACILITY NUMBER:
547208849
ADMINISTRATOR:AGUILAR, MELINDAFACILITY TYPE:
740
ADDRESS:1303 S. PINKAM STTELEPHONE:
(559) 625-1452
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY:10CENSUS: 5DATE:
06/15/2020
UNANNOUNCEDTIME BEGAN:
07:15 AM
MET WITH:Administrator Melinda AguilarTIME COMPLETED:
10:15 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff failed to notify authorized representative of incident.
Staff yells at residents while in care.
INVESTIGATION FINDINGS:
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Administrator (Admin) & staff were interviewed. Facility incident reports were reviewed. All information available indicate that hospice care, responsible party, & the Department were notified of incidents on 7/14/19 & 7/15/19 regarding R1. No information available at this time to support allegation.

Most of the residents in care during various times are hard of hearing & require staff to raise voice to various levels depending on resident's hearing loss in order to communicate with resident. Families are aware of resident's hearing loss & need for persons, including staff, to raise voice in order to communicate with resident. No information available at this time to support allegation.

The Department has investigation the above allegations & found at this time that the allegations are without a reasonable basis & are therefore unfounded.
Unfounded
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: 06/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 2