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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107209348
Report Date: 01/15/2026
Date Signed: 01/15/2026 06:02:40 PM

Substantiated


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
08/01/2025 and conducted by Evaluator Daiquiri Boyd
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20250801141335
FACILITY NAME:FRESNO GUEST HOME #19FACILITY NUMBER:
107209348
ADMINISTRATOR:KUTNERIAN, ANGELICAFACILITY TYPE:
740
ADDRESS:2149 E MENLO AVETELEPHONE:
(559) 434-1839
CITY:FRESNOSTATE: CAZIP CODE:
93710
CAPACITY:6CENSUS: 5DATE:
01/15/2026
UNANNOUNCEDTIME BEGAN:
03:40 PM
MET WITH:Teresa LongTIME COMPLETED:
06:15 PM
ALLEGATION(S):
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Staff did not provide adequate supervision to residents in care
INVESTIGATION FINDINGS:
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On 1/15/2026, Licensing Program Analyst (LPA) Daiquiri Boyd conducted a subsequent complaint investigation visit to the facility. LPA met with Teresa Long and explained the reason for the visit.
During the course of this complaint investigation LPA conducted interviews, obtained and/or reviewed facility and resident records (LIC602A), and reviewed and obtained copy of video recordings from inside the facility from the night of the incident. Interviews conducted and videos reviewed show resident (R1) had left their bedroom, used the restroom and was wandering the facility halls and living area between the general hours of 1 a.m. and 2:30 a.m. Resident made a phone call from the house phone to the daughter in an attempt to seek assistance. Resident (R1) has diagnosed medical condition, as documented on LIC602A. It was determined, based on interviews, videos obtained, and records reviewed, that the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Health and Safety Code Chapter 03.2, Article 03), are being cited on the attached LIC 9099D.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Daiquiri Boyd
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
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-20250801141335
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: FRESNO GUEST HOME #19
FACILITY NUMBER: 107209348
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/15/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/16/2026
Section Cited
HSC
1569.312(a)
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1569.312(a) - Basic Services Requirements-Every facility required to be licensed under this chapter shall provide at least the following basic services: (a) Care and supervision as defined in Section 1569.2. This requirement was not met as evidenced by the statements of witnesses and the
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Faciliity will ensure the phones are placed in the night staff bedroom each night and clients are provided care and supervision.
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video footage obtained from inside the facility showing R1 walking throughout the facility starting at 1:15AM until placing a call to daughter at 1:44AM, opening the alarmed front door for her daughter at 2:06AM. Night Staff was not seen by R1’s daughter that night or on submitted video, until seen at 2:23AM after the Night Shift Supervisor arrived. The floating Night Shift Supervisor arrived at the home between 2:06AM and 2:23AM, as they were seen on video at 2:23AM with the Night Staff as EMS arrived at the facility; which poses an immediate risk to the health, safety, or personal rights risk to the residents in care.
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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: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Daiquiri Boyd
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2