107203982-9-9-2025-24-AS-SMOA-DLKL7A-20250916083001

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107203982
Report Date: 09/09/2025
Date Signed: 09/09/2025 01:05:29 PM

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
08/12/2025 and conducted by Evaluator Jacques Leffall

COMPLAINT CONTROL NUMBER: 24-AS-20250812114532

FACILITY NAME:	SHINING LIGHT RCFE, THE		FACILITY NUMBER:	107203982
ADMINISTRATOR:	GALVEZ, DELIA		FACILITY TYPE:	740
ADDRESS:	2749 W. SAN CARLOS AVENUE		TELEPHONE:	(559) 449-0410
CITY:	FRESNO	STATE: CA	ZIP CODE:	93711
CAPACITY:	6	CENSUS: 5	DATE:	09/09/2025
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Administrator: Carlo Santos		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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8
9

Staff hit resident.

Staff did not assist resident with care needs.

INVESTIGATION FINDINGS:

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13

On 9/9/25 at 11:30 am Licensing Program Analyst (LPA) J. Leffall conducted a subsequent complaint visit to open and to deliver findings on above allegations. LPA met with Staff (S1) Rene Valencia and stated purpos of the visit. Administrator (A1) Carlo Santos was contacted by phone.

The Department conducted an interviews with facility staff, reviewed facility records, resident files and hospital discharge records.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is Unsubstantiated. No deficiencies were issued.

Exit interview conducted. A copy of this report was distributed to Administrator which confirms signature of this report.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Jacques Leffall
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2025

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
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
08/12/2025 and conducted by Evaluator Jacques Leffall

COMPLAINT CONTROL NUMBER: 24-AS-20250812114532

FACILITY NAME:	SHINING LIGHT RCFE, THE		FACILITY NUMBER:	107203982
ADMINISTRATOR:	GALVEZ, DELIA		FACILITY TYPE:	740
ADDRESS:	2749 W. SAN CARLOS AVENUE		TELEPHONE:	(559) 449-0410
CITY:	FRESNO	STATE: CA	ZIP CODE:	93711
CAPACITY:	6	CENSUS: 5	DATE:	09/09/2025
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Administrator: Carlo Santos		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not dispense medications to resident as prescribed.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 9/9/25 at 11:30 am Licensing Program Analyst (LPA) J. Leffall conducted a subsequent complaint visit to deliver findings on above allegation. LPA met with Staff (S1) Rene Valencia and stated purpose of visit. Administrator A1 Carlo Santos was contacted by phone.

The Department conducted interviews, reviewed records and Resident’s MAR’s. Based on the interviews conducted, facility staff failed to administer medications to R1 on the evening that R1 was admitted to facility.

Interviews conducted confirmed that R1 was asleep, and staff made no attempt to administer medications and there was no contact or written report written to the Department of the missed medications/errors.

The preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. See citations on the attached LIC. 9099D per Title 22.

Exit Interview conducted. A copy of this report and appeal rights were distributed to Staff which signature confirms receipt of this report.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Jacques Leffall
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2025

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 3

Control Number 24-AS-20250812114532

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: SHINING LIGHT RCFE, THE	FACILITY NUMBER: 107203982
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/09/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/10/2025 Section Cited CCR 87465(a)(4)	1 2 3 4 5 6 7	a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. Based on records reviewed and interviews conducted, R1’s evening medications were missed which poses an immediate Health & Safety risk to the residents.	1 2 3 4 5 6 7	Licensee agrees to have staff complete medication training and submit completion documents to CCLD by POC due date.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: See Moua
LICENSING EVALUATOR NAME: Jacques Leffall
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 3