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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107206901
Report Date: 12/19/2022
Date Signed: 12/19/2022 11:28:20 AM

Substantiated


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
07/18/2022 and conducted by Evaluator Melinda Medina
COMPLAINT CONTROL NUMBER: 24-AS-20220718163144
FACILITY NAME:A PLACE CALLED HOME RESIDENTIAL CARE 4FACILITY NUMBER:
107206901
ADMINISTRATOR:DAVID C MURCHISONFACILITY TYPE:
740
ADDRESS:2842 CALIMYRNA AVETELEPHONE:
(559) 326-0953
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:6CENSUS: 5DATE:
12/19/2022
UNANNOUNCEDTIME BEGAN:
09:08 AM
MET WITH:David Murchison
Colin Murchison		TIME COMPLETED:
10:54 AM
ALLEGATION(S):
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Licensee does not ensure COVID safety practices are being followed
INVESTIGATION FINDINGS:
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On 12/19/22, Licensing Program Analyst (LPA) M. Medina conducted visit to deliver findings on this complaint. LPA met with David Murchison, Licensee and Colin Murchison, Chief Financial Officer (CFO) and stated purpose of visit.

During the course of the investigation, interviews were conducted and records reviewed. Upon entry for subsequent visit, LPA observed staff to not be wearing masks in facility.

Based on the above information, the preponderance of evidence standard has been met. The allegation that Licensee does not ensure COVID safety practices are being followed is SUBSTANTIATED.

Deficiency cited on the attached 9099 D
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022
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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Control Number 24-AS-20220718163144
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: A PLACE CALLED HOME RESIDENTIAL CARE 4
FACILITY NUMBER: 107206901
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/20/2022
Section Cited
CCR
87468.1(a)(2)
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Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable
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Licensee to ensure that all staff and visitors wear masks while in the facility. POC to be submitted to Fresno Regional Office by due date.
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accommodations, furnishings and equipment. **This was not met as evidenced by LPA arrived to facility on two separate occassions and observed staff to not be wearing masks while working in facility.
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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: 12/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022
LIC9099 (FAS) - (06/04)
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