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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107209044
Report Date: 10/06/2021
Date Signed: 10/07/2021 04:15:17 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
11/13/2020 and conducted by Evaluator Mary Garza
COMPLAINT CONTROL NUMBER: 24-AS-20201113103123
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:
10/06/2021
UNANNOUNCEDTIME BEGAN:
02:37 PM
MET WITH:Administrator, Jill Stowell via phoneTIME COMPLETED:
04:23 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained an unexplained fall while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/06/2021 Licensing Program Analyst (LPA) M Garza contacted facility Administrator to complete a COVID pre-screening. During conversation Administrator, Jill Stowell informed LPA that they were unavailable currently. Administrator stated to complete visit with Caregiver, Lyn Sta. Maria. LPA arrived at facility and completed a Health and Safety check on resident in care. Residents observed in common area and in rooms.

During the course of the investigation interviews were completed and records were reviewed. 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.

Exit interview was conducted with Administrator via telephone. Due to COVID precautionary measures a copy of this report will be email. A delivered and read receipt will serve as confirmation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021
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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