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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107209044
Report Date: 08/05/2021
Date Signed: 08/05/2021 02:40:29 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
07/27/2021 and conducted by Evaluator Les Xiong
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20210727155921
FACILITY NAME:GENIALCAREFACILITY NUMBER:
107209044
ADMINISTRATOR:FLAUTA, LYNETTEFACILITY TYPE:
740
ADDRESS:2374 LAS ROSAS AVETELEPHONE:
(209) 572-5157
CITY:CLOVISSTATE: CAZIP CODE:
93619
CAPACITY:6CENSUS: 6DATE:
08/05/2021
UNANNOUNCEDTIME BEGAN:
02:06 PM
MET WITH:Roselle A. TayagTIME COMPLETED:
03:07 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained an injury while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Les Xiong conducted the complaint investigation visit to the facility. I met with staff Roselle A. Tayag and spoke to Administrator Jill Stowes over the phone letting her know the purpose of the visit.

During the course of this investigation LPA reviewed facility files and interview individuals relevant to the complaint investigation. It was determined that the above allegation: Resident sustained an injury while in care is UNFOUNDED. The investigation indicated Resident R1's medication was given as per doctor's directions and she received care and supervision as per her needs and services plan. This agency has investigated the complaint alleging (Resident sustained an injury while in care). We have found that the complaint was unfounded, therefore we have dismissed the complaint.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Les Xiong
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021
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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