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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157209207
Report Date: 02/07/2025
Date Signed: 02/10/2025 07:06:30 AM

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
10/16/2024 and conducted by Evaluator Rachel A Bruce
COMPLAINT CONTROL NUMBER: 24-AS-20241016233013
FACILITY NAME:YOUR LOVED ONES MATTER LLCFACILITY NUMBER:
157209207
ADMINISTRATOR:JIMENEZ, ISAIFACILITY TYPE:
740
ADDRESS:4804 KENNY STTELEPHONE:
(661) 735-3236
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY:6CENSUS: 6DATE:
02/07/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Isai Jimenez, AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff allow a resident to be soiled for extended periods of time
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rachel Bruce conducted the subsequent complaint investigation visit to the facility for the purpose of delivering the finding on the above allegation that staff would allow a resident to be soiled for extended periods of time.

During the course of this complaint investigation LPA interviewed staff on duty, outside parties, and obtained and reviewed facility records. It was determined based on the interviews, observations, and records review that the above allegation is SUBSTANTIATED. Facility staff did leave patient soiled for extensive periods of time because the resident did not want her diaper changed. Based on the LPAs investigation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22 is being cited on the attached LIC 9099D.

An exit interview was conducted and a copy of this report and appeal rights will be provided via email.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Rachel A Bruce
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025
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 3
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
10/16/2024 and conducted by Evaluator Rachel A Bruce
COMPLAINT CONTROL NUMBER: 24-AS-20241016233013

FACILITY NAME:YOUR LOVED ONES MATTER LLCFACILITY NUMBER:
157209207
ADMINISTRATOR:JIMENEZ, ISAIFACILITY TYPE:
740
ADDRESS:4804 KENNY STTELEPHONE:
(661) 735-3236
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY:6CENSUS: 6DATE:
02/07/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Isai Jimenez, Administrator TIME COMPLETED:
03:00 PM
ALLEGATION(S):
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9
Staff neglect resulted in a resident developing multiple pressure injuries
Staff do not properly position a resident
Staff mishandled a resident's medication
Staff do not meet a resident's incontinence needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rachel Bruce conducted an unannounced facility visit to deliver findings on the allegations listed above. LPA met with Licensee/Administrator to review findings.

The Department has investigated the complaint alleging that: Staff neglect resulted in resident developing pressure wounds; staff did not properly position a resident; staff mishandled a resident's medication and the staff did not meet a resident's incontinence needs. Based on the interviews conducted and records review the above allegations are UNSUBSTANTIATED. Although the allegations may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

Exit interview conducted with Administrator and a copy of the signed report provided via email.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Rachel A Bruce
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 24-AS-20241016233013
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: YOUR LOVED ONES MATTER LLC
FACILITY NUMBER: 157209207
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/14/2025
Section Cited
HSC
1569.2(c)
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"Care and supervision" means the facility assumes responsibility for, or provides...ongoing assistance with activities of daily living without which the resident’s physical health... would be endangered. Assistance includes assistance with taking medications, money management, or personal care.
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Facility stated that they will train the staff that going forward they will contact the responsible party to intercede or assist with when a resident is refusing treatment or assistance. Ongoing assessment completed to ensure facility can meet client's needs.
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This requirement was not met as evidenced by the resident would refuse to get her diaper changed resulting in her being soiled for long periods of time resulting in an immediate risk to the health, safety or personal rights of the resident in care.
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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: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Rachel A Bruce
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3