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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107209239
Report Date: 06/24/2025
Date Signed: 06/24/2025 07:53:58 PM

Substantiated


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
03/11/2025 and conducted by Evaluator Kelly J. McClurg
COMPLAINT CONTROL NUMBER: 24-AS-20250311155806
FACILITY NAME:JAN-ROY PLACE OF FRESNO 2FACILITY NUMBER:
107209239
ADMINISTRATOR:HOPPER, JOYCELYN B.FACILITY TYPE:
740
ADDRESS:4266 N 9TH STREETTELEPHONE:
(559) 940-9708
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY:6CENSUS: 4DATE:
06/24/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:CareGiver (CG) Augusto Arroyo & Care Coordinator (CC) Ana Marie GregorioTIME COMPLETED:
08:00 PM
ALLEGATION(S):
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Staff did not ensure proper supervision was provided to resident in care.
INVESTIGATION FINDINGS:
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An unannounced Complaint visit was conducted by Licensing Program Analyst (LPA) K. McClurg. LPA met with CareGiver (CG) Augusto Arroyo. LPA greeted CG, introduced self, stated purpose of visit, provided business card, & was allowed entry. LPA was joined during visit by Care Coordinator (CC) Ana Marie Gregorio.

Incident regarding Former Client (FC) discussed. It was confirmed that an incident occurred where FC was dropped off at health services location. FC wandered away from area unobserved. Fresno PD contacted. FC located in another part of town. Client was known to occasionally wander & it was indicated they were not to leave the facility unassisted. When client was located, they were observed to be confused & disoriented. No known physical injuries as a result of this incident.

The Department has investigated the above allegation & determined it to be SUBSTANTIATED.

DEFICIENCY ISSUED.
Exit interview conducted with CC. Report provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2025
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-20250311155806
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: JAN-ROY PLACE OF FRESNO 2
FACILITY NUMBER: 107209239
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/25/2025
Section Cited
CCR
87465(a)(2)
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Incidental Medical and Dental Care. The licensee shall provide assistance in meeting necessary medical and dental needs. Client with tendency to wander was dropped off unassisted @ care services location. C1 did wander away & Fresno PD were contacted. C1 located in another part of town. This violation poses an immediate risk.
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CC agreed to submit a plan of facility protocol for accompanying clients & providing assistance for medical & dental needs. Plan should include training & date training will be conducted. To be submitted to LPA by due date. Failure to submit timely may result in Civil Penalties.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2