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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107209063
Report Date: 02/05/2025
Date Signed: 02/05/2025 03:51:18 PM

Unfounded


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
11/18/2024 and conducted by Evaluator Daiquiri Boyd
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20241118105309
FACILITY NAME:FRESNO GUEST HOME #13FACILITY NUMBER:
107209063
ADMINISTRATOR:KUTNERIAN, ANGELICAFACILITY TYPE:
740
ADDRESS:2076 E FREMONT AVETELEPHONE:
(559) 434-1839
CITY:FRESNOSTATE: CAZIP CODE:
93710
CAPACITY:6CENSUS: 6DATE:
02/05/2025
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Teresa LongTIME COMPLETED:
03:50 PM
ALLEGATION(S):
1
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9
Staff administer suppositories to residents in care
Facility is not kept free of hazards
Staff did not inform resident's physician of resident's change of condition
Staff gave another resident's prescribed medication to resident in care
INVESTIGATION FINDINGS:
1
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3
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Licensing Program Analyst (LPA) Daiquiri Boyd conducted the complaint investigation visit to the facility.
During the course of this investigation LPA reviewed facility files relevant to the complaint investigation and interviewed staff. It was determined that the above allegations: Staff administer suppositories to residents in care, facility is not kept free of hazards, staff did not inform resident's physician of resident's change of condition, and staff gave another resident's prescribed medication to resident in care are UNFOUNDED. LPA interviewed Administrators and staff and reviewed client records and found that the staff did not administer suppositories to resident and no charting in the file. Staff reported that hazardous items are kept locked and LPA did not observe any dangers. Staff reported that they notify Administrator when there are changes with residents and LPA observed updated notes in residents files. When interviewed, staff reported that all medications are logged and no one gets anyone else's medications. LPA reviewed med logs and found no errors. 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: Daiquiri Boyd
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025
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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