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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157209103
Report Date: 03/04/2025
Date Signed: 03/04/2025 02:47:51 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
12/05/2024 and conducted by Evaluator Rachel A Bruce
COMPLAINT CONTROL NUMBER: 24-AS-20241205100619
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:
03/04/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Shirley Dillard, Licensee TIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff violate client's personal rights
Medication mishandled by staff
Neglect / lack of supervision resulting in an injury
INVESTIGATION FINDINGS:
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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 investigative findings regarding the allegations listed above and described below.
Allegation 1- Personal Rights violation - not enough clothing or proper toiletries- LPA conducted tour and found that at the time of the visit, clients had sufficient clothing and there were appropriate toiletry items for staff and clients. Interviews conducted provided conflicting information regarding supplies.
Allegation 2- Medical violation- not enough medication- clients share and medication is physically mishandled. LPA conducted tour and conducted interviews. At the time of the visit, medication appeared to be in order. Interviews conducted provided conflicting information regarding how medication is handled in the facility and the way that is stored and distributed.
Allegation 3- Neglect / lack of supervision resulting in an injury- This was concerning a resident who had a broken finger due to mistreatment. No records of that being reported to staff were found. The other issue referenced that the same client was mistreated verbally and was left in their room in the wheelchair. LPA conducted tour and interviews which revealed conflicting information and no record of the above found in documentation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Rachel A Bruce
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025
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-20241205100619
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: AAA RESIDENTIAL ELDERLY RETREAT
FACILITY NUMBER: 157209103
VISIT DATE: 03/04/2025
NARRATIVE
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The Department has concluded the investigation regarding the complaint and the allegations noted above. LPA conducted tours and interviews and received conflicting information. Based on the information received the above allegations are 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 allegations are found to be unsubstantiated.

No citations were issued regarding the allegations at today's visit. An exit interview was conducted and a copy of the report and appeal rights was provided to the Licensee whose signature acknowledges receipt.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Rachel A Bruce
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2