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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157209146
Report Date: 01/20/2025
Date Signed: 01/20/2025 10:06:34 AM

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
11/01/2024 and conducted by Evaluator Shawna Doucette
COMPLAINT CONTROL NUMBER: 24-AS-20241101104516
FACILITY NAME:QUALITY CARE ASSISTED LIVINGFACILITY NUMBER:
157209146
ADMINISTRATOR:ESPINAL, ALMAFACILITY TYPE:
740
ADDRESS:2607 MT. VERNON AVENUETELEPHONE:
(661) 871-8133
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93306
CAPACITY:54CENSUS: 45DATE:
01/20/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator Nancy CudalTIME COMPLETED:
10:15 AM
ALLEGATION(S):
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Resident's hygiene needs are not being met
Residents bed sheets are not being changed
Transportation for appointments not provided
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced complaint visit and was granted entry by Administrator Nancy Cudal. LPA explained the purpose of the visit.

LPA toured the facility. LPA checked resident's room. Resident was not at the facility during visit. On 1/17/24, LPA attempted to interview R1 via telephone however R1 is unable to communicate verbally due to a medical condition.

Based on interviews and records review, it is undetermined whether or not the facility is meeting the residents needs. LPA reviewed resident records, indicating resident is receiving prescribed medications. LPA reviewed shower schedule indicating resident is receiving showers weekly. LPA reviewed LIC602 indicating resident can leave the facility unassisted.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2025
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-20241101104516
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: QUALITY CARE ASSISTED LIVING
FACILITY NUMBER: 157209146
VISIT DATE: 01/20/2025
NARRATIVE
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Based on observatoin and interviews, LPA toured the faciliity on 1/16/24, and observed bedding on R1's bed. LPA toured the facility today and room was in the process of be cleaned and sheets were being changed.

Based on records review and interviews, R1 has a current LIC 602. Facility doctors schedule visits to see resident's at the facility. R1 saw the Psychiatrist on December 18, 2024 and will see the Psychiatrist today. R1 was not at the facility during the visit and was out in the community.

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.

A copy of this report was provided.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2