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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157209103
Report Date: 03/03/2025
Date Signed: 03/04/2025 02:17:39 PM

Unsubstantiated


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
12/19/2024 and conducted by Evaluator Rachel A Bruce
COMPLAINT CONTROL NUMBER: 24-AS-20241219100153
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:
03/03/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Shirley Dillard, LicenseeTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
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5
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7
8
9
Staff interacted with resident in an inappropriate manner.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 3/4/2025, Licensing Program Analyst (LPA) Rachel Bruce conducted an unannounced complaint investigation visit to the facility. During this visit LPA delivered the investigation finding regarding the above allegation.

The Department has investigated the complaint alleging that a staff member interacted with a resident inappropriately by the way the resident was physically handled; specifically the manner which client was moved in his wheelchair. Staff involved indicated it was not rough just a matter of directing traffic. LPA conducted interviews and received conflicting information. Based on the interviews conducted and/or records review the above allegation is UNSUBSTANTIATED. Although the allegation may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is found to be unsubstantiated.

No citation issued regarding the allegation. An exit interview was conducted and a copy of the report and appeal rights was provided to the Licensee whose signature acknowledges receipt.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Rachel A Bruce
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2025
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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