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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107209246
Report Date: 09/21/2024
Date Signed: 09/28/2024 08:15:59 PM

Unfounded


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
07/16/2024 and conducted by Evaluator Lisa Salazar
COMPLAINT CONTROL NUMBER: 24-AS-20240716083711
FACILITY NAME:LAURITE SENIOR CARE HOMEFACILITY NUMBER:
107209246
ADMINISTRATOR:SISON, EDDIEMERFACILITY TYPE:
740
ADDRESS:5478 E LAURITE AVETELEPHONE:
(559) 573-7999
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY:6CENSUS: DATE:
09/21/2024
UNANNOUNCEDTIME BEGAN:
01:38 PM
MET WITH:Eddiiemer "Bang" Sison, Administrator
Innocent Idusuyi, Licensee 		TIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not issue a refund
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 09/21/24, Licensing Program Analyst (LPA) L. Salazar arrived at the faciiity unannounced to deliver findings on the above allegation. LPA was greeted by caregiver, stated the purpose of the visit an was allowed entry into the facility. Administrator and Licensee arrived shortly after.

This Department investigated the allegation, based on the interviews with Administrator and family, facility issued the refund to the Daughter of Resident R1 and not the grandson of R1. Based on the information received, we have found that the allegation, Staff did not issue a refund is Unfounded, meaning that the allegation is false, could not have happened and/or is without reasonable basis, therefore, we have dismissed the complaint.

Exit interview conducted. A copy of this report was provided to Administrator at the time of visit. No deficiencies cited.

Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2024
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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