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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107208930
Report Date: 11/21/2024
Date Signed: 11/21/2024 05:14:28 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
08/16/2024 and conducted by Evaluator Martin Vega
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20240816165008
FACILITY NAME:WINDHAM, THEFACILITY NUMBER:
107208930
ADMINISTRATOR:EARLEY, JOHNFACILITY TYPE:
740
ADDRESS:1100 E SPRUCE AVETELEPHONE:
(559) 449-8070
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:88CENSUS: 81DATE:
11/21/2024
UNANNOUNCEDTIME BEGAN:
03:40 PM
MET WITH:Licensee - John EarlyTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Staff did not properly supervise resident, resulting in death.
INVESTIGATION FINDINGS:
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On 11/21/2024, Licensing Program Analyst (LPA) M Vega conducted an unannounced complaint inspection at 1540 hours. LPA met with Licensee John Earley. The purpose of this visit is to deliver the finding of the investigation completed by the Department.

LPA conducted a tour of the facility, interior and exterior to ensure there are no potential or immediate health and safety risk at the facility.

On 08/16/2024, the Department received a report alleging that staff did not properly supervise resident, resulting in death.

Continuation on LIC 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Martin Vega
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
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 2
Control Number 24-AS-20240816165008
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: WINDHAM, THE
FACILITY NUMBER: 107208930
VISIT DATE: 11/21/2024
NARRATIVE
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The Department conducted interviews and record reviews. On 07/22/2024, Resident (R1) was found deceased in an empty file adjacent to the facility. Local police department noted no foul play. Due to R1 dying of natural causes and R1’s history of disease, it cannot be determined that staff’s lack of care and supervision resulted in R1’s death.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the above allegation is unsubstantiated, at this time.

An exit interview was conducted, and a copy of this report dated 11/21/2024 along with appeal rights were provided to licensee.

No deficiencies were cited during this visit.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Martin Vega
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2