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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157209106
Report Date: 10/15/2025
Date Signed: 10/15/2025 12:36:37 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
10/11/2025 and conducted by Evaluator Jimmy Duarte
COMPLAINT CONTROL NUMBER: 24-AS-20251011213720
FACILITY NAME:TLC HOME CARE 1FACILITY NUMBER:
157209106
ADMINISTRATOR:ARRIETA, RODRIGO A. JR.FACILITY TYPE:
740
ADDRESS:5801 COCHRAN DRIVETELEPHONE:
(661) 558-4499
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY:6CENSUS: 6DATE:
10/15/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Rodrigo ArrietaTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Staff are locking resident in bedroom.
Staff does not ensure resident is provided clean linen.
INVESTIGATION FINDINGS:
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On 10/15/25, Licensing Program Analysts (LPAs) J. Duarte and M. Medina, conducted the 10-day complaint investigation visit to the facility. LPAs met with Direct Care Staff (DCS). Administrator, Rodrigo Arrieta, was contacted via telephone and he arrived shortly after.

During the complaint investigation, LPAs conducted a facility tour, conducted interviews, and reviewed documentation received. Based on interviews and review of documentation, Resident One (R1) was locked in bedroom due to wandering. Per information gathered during interviews, staff stated that R1 had a mattress on the floor without linen because R1 removes all linen and bedding, and goes under the bed, so the mattress was placed on the floor to avoid potential injury.

The preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Jimmy Duarte
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025
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-20251011213720
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: TLC HOME CARE 1
FACILITY NUMBER: 157209106
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/16/2025
Section Cited
CCR
87468.1(a)(3)
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87468.1 Personal Rights of Residents in All Facilities

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:
(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination.
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LPA observed R1 to have a hospital bed and linen available.
Licensee stated that the locks will be removed from R1's bedroom by POC due date of 10/16/25 and email proof to LPA.
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This requirement was not met as evidenced by: Based on interviews, observation, and review of documentation: R1 was locked in bedroom due to wandering. In addition, R1 had a mattress on the floor without linen because R1 removes all linen and bedding, and goes under the bed, so the mattress was placed on the floor to avoid potential injury.
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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: Serigy Pidgirny
LICENSING EVALUATOR NAME: Jimmy Duarte
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2