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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 547208883
Report Date: 08/22/2024
Date Signed: 08/23/2024 07:58:00 AM

Unsubstantiated


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
02/09/2024 and conducted by Evaluator Lisa Salazar
COMPLAINT CONTROL NUMBER: 24-AS-20240209110051
FACILITY NAME:PEOPLE'S CARE AVENUE 344FACILITY NUMBER:
547208883
ADMINISTRATOR:ENNIS, KRISTINFACILITY TYPE:
738
ADDRESS:14453 AVENUE 344TELEPHONE:
(559) 798-1655
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY:4CENSUS: 4DATE:
08/22/2024
UNANNOUNCEDTIME BEGAN:
07:09 PM
MET WITH:Jose Marquez, District ManagerTIME COMPLETED:
08:30 PM
ALLEGATION(S):
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9
Staff do not seek timely medical attention for residents.
Personal Rights Violation
Staff falsify facility documents.
INVESTIGATION FINDINGS:
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9
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13
On 08/22/24, Licensing Program Analyst (LPA) L. Salazar met with District Manager, to deliver findings on the above allegations.

Based on records review and interviews conducted, although the allegations may have happened, there is not a preponderance of evidence to prove that the alleged violations occurred, therefore the allegations are Unsubstantiated.

Exit interview conducted. No deficiencies cited.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
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 3
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
02/09/2024 and conducted by Evaluator Lisa Salazar
COMPLAINT CONTROL NUMBER: 24-AS-20240209110051

FACILITY NAME:PEOPLE'S CARE AVENUE 344FACILITY NUMBER:
547208883
ADMINISTRATOR:ENNIS, KRISTINFACILITY TYPE:
738
ADDRESS:14453 AVENUE 344TELEPHONE:
(559) 798-1655
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY:4CENSUS: 4DATE:
08/22/2024
UNANNOUNCEDTIME BEGAN:
07:09 PM
MET WITH:Jose Marquez, District ManagerTIME COMPLETED:
08:30 PM
ALLEGATION(S):
1
2
3
4
5
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8
9
Staff mismanage residents’ medications.
Licensee does not ensure staff are appropriately trained to provide care to residents.
INVESTIGATION FINDINGS:
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3
4
5
6
7
8
9
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11
12
13
On 08/22/24, Licensing Program Analyst (LPA) L. Salazar met with District Manager, to deliver findings on the above allegations.

Based on records review and interviews conducted, the preponderance of evidence standard has been met; therefore, the above allegations are found to be Substantiated. Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are being cited on the attached 9099-D.

An exit interview was conducted with Distrcit Manager. A copy of this report and appeal rights were discussed and provided at the time of visit. Plans of corrections were developed and completed by licensee prior to LPA's visit today. Exit interview conducted. No deficiencies cited.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 24-AS-20240209110051
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: PEOPLE'S CARE AVENUE 344
FACILITY NUMBER: 547208883
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/22/2024
Section Cited
CCR
82165(b)
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82165 Emergency Intervention Staff Training
(b) Staff who use, participate in, approve or provide visual checks of manual restraint or seclusion, shall have a minimum of sixteen hours of emergency intervention training and be certified for having successfully completed the training.
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Licensee provided copies of current CPI certifications evidencing the required 16 hours of emergency intervention training for all staff.
** POC cleared **
Type B
08/30/2024
Section Cited
CCR
80075(a)
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80075 (a) The licensee shall ensure that each client receives necessary first aid and other needed medical or dental services, including arrangement for and/or provision of transportation to the nearest available services.
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Licensee has been conducting consistent Quality Assurance checks and medication training prior to LPAs arrival.** POC cleared **
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7
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7
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7
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3