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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 547209374
Report Date: 07/08/2025
Date Signed: 07/09/2025 08:41:40 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 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
06/30/2025 and conducted by Evaluator Lisa Salazar
COMPLAINT CONTROL NUMBER: 24-AS-20250630132724
FACILITY NAME:GRAND OAKS ASSISTED LIVINGFACILITY NUMBER:
547209374
ADMINISTRATOR:SHELLHAMER, DAVIDFACILITY TYPE:
740
ADDRESS:999 NORTH M STREETTELEPHONE:
(559) 684-1001
CITY:TULARESTATE: CAZIP CODE:
93274
CAPACITY:85CENSUS: 58DATE:
07/08/2025
UNANNOUNCEDTIME BEGAN:
09:47 AM
MET WITH:David Shellhammer, Administrator TIME COMPLETED:
06:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee is not ensuring that staff are seeking medical attention for resident as necessary.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 07/08/25, Licensing Program Analyst (LPA) L. Salazar arrived to the facility unannounced to conduct the required 10 day site visit. LPA was greeted by Administrator, stated the purpose of the visit and was allowed entry into the facility. LPA met with Administrator and Residential Care Coordinator (RCC) to discuss the allegation.

During the investigation, LPA toured the facility, reviewed Resident R1's records and interviewed staff. Based on the information received, R1 was admitted on Infinite Heart Hospice on 06/04/25 with a plan of care to include Hospice Nursing visits and Home Health visits . LPA observed Hospice records including the plan of care , nursing visits and assessments. Medical attention is being provided. Although the allegation may have happened, there is not a preponderance of evidence to prove that the alleged violation occurred, therefore the allegation is Unsubstantiated.

Exit interview conducted and copy of report was left with Administrator. No deficiency cited on this visit.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
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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