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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107204172
Report Date: 02/05/2025
Date Signed: 02/05/2025 03:52:36 PM

Unfounded


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
11/18/2024 and conducted by Evaluator Daiquiri Boyd
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20241118112636
FACILITY NAME:FRESNO GUEST HOME #1FACILITY NUMBER:
107204172
ADMINISTRATOR:LONG, TERESAFACILITY TYPE:
740
ADDRESS:6538 N. CHANCETELEPHONE:
(559) 434-1839
CITY:FRESNOSTATE: CAZIP CODE:
93710
CAPACITY:6CENSUS: 5DATE:
02/05/2025
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Teresa LongTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff administer injections to residents in care
Staff force residents to walk
Staff are not following resident's hospice care plan
Staff administer suppositories to residents in care
Facility staff installed cameras in resident rooms
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Daiquiri Boyd conducted the complaint investigation visit to the facility.
During the course of this investigation LPA reviewed facility files relevant to the complaint investigation and interviewed staff. It was determined that the above allegations: Staff administer injections to residents in care, staff force residents to walk, staff are not following resident's hospice care plan, staff administer suppositories to residents in care, and facility staff installed cameras in resident rooms are UNFOUNDED. As a result of interviews and file review, no evidence was reported or found indicating that any staff has administered injections. Staff reported that they encourage residents to take walks and no one forces any residents to participate in activities they do not want to do. Additionally, LPA viewed pictures of the resident that the complainant was referring to, on a walk waving and smiling. LPA interviewed staff and all stated they follow the hospice care plans that the Administrator has developed in collaboration with hospice worker. LPA observed hospice plans in resident files. LPA interviewed Administrators and staff and reviewed client records and found that the staff did not administer suppositories to resident and no charting ... (continued on LIC9099C)
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Daiquiri Boyd
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025
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 2
Control Number 24-AS-20241118112636
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: FRESNO GUEST HOME #1
FACILITY NUMBER: 107204172
VISIT DATE: 02/05/2025
NARRATIVE
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in the file. The facility has a fall detection system in the home and doesn't have cameras installed. We have found that the complaint was unfounded, therefore we have dismissed the complaint.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Daiquiri Boyd
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2