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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107208812
Report Date: 04/17/2024
Date Signed: 04/17/2024 02:43:46 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
04/15/2024 and conducted by Evaluator Alexandria Walton
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20240415152512
FACILITY NAME:CATUIRA HOMEFACILITY NUMBER:
107208812
ADMINISTRATOR:MARIA A RECENOFACILITY TYPE:
740
ADDRESS:712 FILBERT AVETELEPHONE:
(559) 299-7167
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:6CENSUS: 4DATE:
04/17/2024
UNANNOUNCEDTIME BEGAN:
02:31 PM
MET WITH:Admininstrator, Sara GloriaTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained unexplained bruising while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 04/17/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to deliver findings on the above allegation. LPA introduced myself and met with Administrator, Sara Gloria. The purpose of the vist was disclosed to Administrator.

Review of resident records and interviews with Administrator revealed that on 04/10/2024, R1 had an appointment to have blood drawn. During the appointment the Lab technician made three attempts to draw blood from R1 resulting in bruising to R1's right arm.

This agency has investigated the allegation: Resident sustained unexplained bruising while in care. We have found that the complaint is unfounded, meaning that the allegation was false, could not have happened and/or without a reasonable basis.

An exit interview was conducted Administrator. A copy of this report was discussed and left with Administrator, Sara Gloria, whose signature on this form confirms receipt of the document.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024
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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