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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 08:02:05 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
06/15/2025 and conducted by Evaluator Kelly J. McClurg
COMPLAINT CONTROL NUMBER: 24-AS-20250615224327
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 Gregorio.TIME COMPLETED:
08:00 PM
ALLEGATION(S):
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Staff did not ensure that medications were inaccessible to clients.
Staff did not seek medical attention for client in a timely manner
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.

Previous incident was reviewed with CC during this visit.
Emergency services not contacted directly after discovery of medication with C1. See below.

Facility personnel found Client 1 (C1) with medications belonging to an unknown person. Could not determine where medication had been obtained. Rx: Amlodipine 10mg. Medications removed from Client 1 & secured. Personnel could not determine if C1 had taken any of medication. Medications origin unknown as name on prescription did not belong to any facility staff, current clients, or former clients. However due to the fact that during this visit medications to be were observed to be unlocked, the allegation has been Substantiated.

The above allegations were investigated by the Department & determined to be SUBSTANTIATED.

DEFICIENCIES ISSUED.

Exit interview conducted with CC. Copy of 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-20250615224327
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(h)(2)
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Incidental Medical and Dental Care. Centrally stored medicines shall be kept in a safe & locked place not accessible to persons other than employees...
C1 observed to be in possession of medication belonging to persons unknown. Origin unknown. However medications observed to be unlocked & accessible during this visit. This violation poses an immediate risk to clients.
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CC agreed to submit updated facility policy with subsequent plan when policy will be updated, including specific date for facility staff training.
Copy of plan to be submitted to LPA by due date. Failure to submit on time may result in Civil Penalty
Type A
06/25/2025
Section Cited
CCR
87465(g)
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Incidental Medical and Dental Care. The licensee shall immediately telephone 911 if an injury or other circumstance has resulted in an...threat to a resident’s health... Facility did not contact &/or notify emergency services, medical personal, or poison control after finding C1 in possession of Rx & unknown if C1 had taken any of Rx. This violation poses an immediate risk to residents.
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CC agreed to submit updated facility policy with subsequent plan when policy will be updated, including specific date for facility staff training.
Copy of plan to be submitted to LPA by due date. Failure to submit on time may result in Civil Penalty
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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