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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107204171
Report Date: 09/12/2024
Date Signed: 11/14/2024 12:10:10 PM

Unfounded


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
10/25/2023 and conducted by Evaluator Melinda Medina
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20231025154539
FACILITY NAME:FRESNO GUEST HOME #2FACILITY NUMBER:
107204171
ADMINISTRATOR:KUTNERIAN, NAZELIFACILITY TYPE:
740
ADDRESS:2214 E. WARNERTELEPHONE:
(559) 434-1839
CITY:FRESNOSTATE: CAZIP CODE:
93710
CAPACITY:6CENSUS: 6DATE:
09/12/2024
UNANNOUNCEDTIME BEGAN:
09:22 AM
MET WITH:Angela KutnerianTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Facility staff do not maintain passageways free from obstruction
INVESTIGATION FINDINGS:
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On 9/12/24, Licensing Program Analyst (LPA) M. Medina conducted an unannounced complaint visit to deliver complaint findings. LPA introduced self, stated purpose of visit, and allowed entrance by staff. Executive Director, Teresa Long contacted by telephone and arrived to conduct complaint visit with LPA.

This department investigated the above allegation, during the investigation, facility was toured, interviewed conducted and records reviewed.

Based on information gathered during investigation, This Department has found that the above allegation is UNFOUNDED, meaning they were false, could not have happened, and/or were without reasonable basis. We have therefore dismissed the complaint.

Exit interview was conducted and a plan of correction developed and reviewed. A copy of this report provided to Administrator for facility records.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
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
Citations on this Visit Report are Under Appeal!

Control Number 24-AS-20231025154539
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: FRESNO GUEST HOME #2
FACILITY NUMBER: 107204171
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal

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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: Melinda Medina
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 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
10/25/2023 and conducted by Evaluator Melinda Medina
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20231025154539

FACILITY NAME:FRESNO GUEST HOME #2FACILITY NUMBER:
107204171
ADMINISTRATOR:KUTNERIAN, NAZELIFACILITY TYPE:
740
ADDRESS:2214 E. WARNERTELEPHONE:
(559) 434-1839
CITY:FRESNOSTATE: CAZIP CODE:
93710
CAPACITY:6CENSUS: 6DATE:
09/12/2024
UNANNOUNCEDTIME BEGAN:
09:22 AM
MET WITH:Teresa Long, Executive DirectorTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Licensee financially abused resident.
Licensee did not provide current admission agreement to resident's responsible person.
Facility staff did not assist resident with dressing as needed.
Facility staff did not meet resident's hygiene needs.
Facility staff did not safeguard resident's personal belongings.
Facility staff did not assist resident with ambulating as needed.
Facility staff do not provide activities for the residents.
Facility staff unable to communicate with resident's responsible person.
INVESTIGATION FINDINGS:
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On 9/12/24, Licensing Program Analyst (LPA) M. Medina conducted an unannounced complaint visit to deliver complaint findings. LPA introduced self, stated purpose of visit, and allowed entrance by staff. Executive Director, Teresa Long contacted by telephone and arrived to conduct complaint visit with LPA.

Based on information gathered during investigation, This Department has found that the above allegations are UNFOUNDED, meaning they were false, could not have happened, and/or were without reasonable basis. We have therefore dismissed the complaint.

No deficiencies issued during this complaint visit . Exit interview conducted. A copy of this report was provided to Administrator for facility records
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
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