547209004-10-5-2022-24-AS-SPIY-CKALJX-20221017084840

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 547209004
Report Date: 10/05/2022
Date Signed: 10/05/2022 02:14:40 PM

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
06/06/2022 and conducted by Evaluator Shawna Doucette

COMPLAINT CONTROL NUMBER: 24-AS-20220606101550

FACILITY NAME:	QUAIL PARK AT SHANNON RANCH		FACILITY NUMBER:	547209004
ADMINISTRATOR:	MOYER, JEFF		FACILITY TYPE:	740
ADDRESS:	3330 & 3440 W FLAGSTAFF AVE		TELEPHONE:	(559) 527-8245
CITY:	VISALIA	STATE: CA	ZIP CODE:	93291
CAPACITY:	150	CENSUS: 89	DATE:	10/05/2022
		UNANNOUNCED	TIME BEGAN:	09:01 AM
MET WITH:	Administrator Jeff Moyer		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Resident sustained multiple injuries while in care
Staff do not use a hoyer lift for resident in care
Medication not dispensed at scheduled time
Staff do not following doctor's orders
Unqualified or untrained staff providing care
Staff make residents get up at early hours of the morning.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced complaint visit to deliver findings. LPA met with Administrator Jeff Moyer and discussed the purpose of the visit.

The Department has investigated the allegations: Resident sustained multiple injuries while in care, Staff do not use a hoyer lift for resident in care, Medication not dispensed at scheduled time, Staff do not following doctor's orders, Unqualified or untrained staff providing care and Staff make residents get up at early hours of the morning.

Based on record review and interviews, R1did fall however facility followed proper procedures and sought medical attention for R1.

Based on records review and interviews, R1 did not have prescription for a hoyer lift and could get up with assistance from facility staff.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna Doucette	TELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022

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
06/06/2022 and conducted by Evaluator Shawna Doucette

COMPLAINT CONTROL NUMBER: 24-AS-20220606101550

FACILITY NAME:	QUAIL PARK AT SHANNON RANCH		FACILITY NUMBER:	547209004
ADMINISTRATOR:	MOYER, JEFF		FACILITY TYPE:	740
ADDRESS:	3330 & 3440 W FLAGSTAFF AVE		TELEPHONE:	(559) 527-8245
CITY:	VISALIA	STATE: CA	ZIP CODE:	93291
CAPACITY:	150	CENSUS: 89	DATE:	10/05/2022
		UNANNOUNCED	TIME BEGAN:	09:01 AM
MET WITH:	Administrator Jeff Moyer		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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2
3
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9

Staff did not seek timely medical attention for resident in care

INVESTIGATION FINDINGS:

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5
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Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced complaint visit to deliver findings. LPA met with Administrator Jeff Moyer and discussed the purpose of the visit.
:
The Department has investigated the allegation: Staff did not seek timely medical attention for resident in care.

Based on interviews and record review/doctor orders and facility notes, facility continued to seek medical treatment for R2. We have found that the complaint was UNFOUNDED, meaning that the allegation is false, could not have happened, and/or is without a reasonable basis, therefore we have dismissed the complaint.

An exit interview was conducted and a copy of this report was provided.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna Doucette	TELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022

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-20220606101550

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: QUAIL PARK AT SHANNON RANCH	FACILITY NUMBER: 547209004
	VISIT DATE: 10/05/2022

NARRATIVE

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Based on records review and interviews, Facility was in the process of changing R4's medication times with the doctor to meet the residents needs. The MARs log reflects the old times and new times of medication distribution for R4.

Based on records review and interviews, R4's doctor orders were not clear for medication distribution. Facility contacted doctor for approval to have medications distributed at R4's requested times.

Based on records review of 3 staff, facility staff has appropriate training.

Based on interviews, staff do not make residents get up early in the morning.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted and a copy of this report was provided.

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna Doucette	TELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3