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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107209044
Report Date: 10/01/2021
Date Signed: 10/01/2021 03:56:25 PM

Unsubstantiated


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
12/16/2020 and conducted by Evaluator Les Xiong
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20201216143828
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:
10/01/2021
UNANNOUNCEDTIME BEGAN:
03:17 PM
MET WITH:Roselle A. TayagTIME COMPLETED:
04:33 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained injury while in care.
Lack of supervision resulted in resident AWOL.
Unlawful eviction.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) L. Xiong conducted the complaint investigation visit to the facility. During this visit LPA delivered investigation findings regarding the above allegations. I met with staff Roselle A. Tayag and spoke to Jill Stowell, Administrator and inform them the purpose of the visit.

The Department has investigated the complaint alleging: Resident sustained injury while in care, lack of supervision resulted in resident AWOL and unlawful eviction. Based on the interviews conducted and/or records review the above allegations are UNSUBSTANTIATED. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Les Xiong
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021
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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