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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107204178
Report Date: 05/17/2023
Date Signed: 05/17/2023 11:58:59 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 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
04/04/2023 and conducted by Evaluator Briana Placencia
PUBLIC
COMPLAINT CONTROL NUMBER: 24-CR-20230404105935
FACILITY NAME:QUALITY FAMILY SERVICES-GETTYSBURGFACILITY NUMBER:
107204178
ADMINISTRATOR:LAW, CORYFACILITY TYPE:
733
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:6CENSUS: 3DATE:
05/17/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Laura RomeroTIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Client received a bruise on arm from staff.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Briana Placencia conducted a complaint inspection at Coorporate office and met with Laura Romero. The purpose of the inspection was to deliver the findings for the above complaint allegation. This complaint is being closed at the corporate office due to Gettysburg being on COVID restrictions.

During the investigation, LPA conducted interviews, records review and reviewed supporting documents provided by the facility. Based on confidential interviews and other information obtained, the department has made the following determination. Although the allegation may have happened or is valid, there is not a preponderance of evidence to provide the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted, and a copy of this report was left at the facility.
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Juanita Arroyo
LICENSING EVALUATOR NAME: Briana Placencia
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023
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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