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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157209103
Report Date: 11/08/2024
Date Signed: 11/08/2024 05:13:39 PM

Unsubstantiated


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
07/22/2024 and conducted by Evaluator Shawna Doucette
COMPLAINT CONTROL NUMBER: 24-AS-20240722153956
FACILITY NAME:AAA RESIDENTIAL ELDERLY RETREATFACILITY NUMBER:
157209103
ADMINISTRATOR:BELL, ALEXIS EFACILITY TYPE:
740
ADDRESS:4313 MONITOR STREETTELEPHONE:
(661) 213-6798
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY:6CENSUS: 6DATE:
11/08/2024
UNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Administrator Alexis Bell TIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff handled resident in a rough manner
Facility is not meeting food service requirements resulting in weight loss
Staff violate resident's personal rights
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPA)'s Shawna Doucette conducted an unannounced complaint visit and was granted entry by Administrator Alexis Bell. LPA's explained the purpose of the visit.

LPA conducted interviews and reviewed records.

Based on record review and interviews Staff documentation indicates R1 refused meals regularly.
Based on interviews, staff did not violate resident's personal rights or handle resident in a rough manner

Based on record reviews and interviews, Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted and a copy of this report was provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024
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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