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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 547209088
Report Date: 11/08/2021
Date Signed: 11/08/2021 03:29:15 PM

Substantiated


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
11/03/2021 and conducted by Evaluator Mai Yang
COMPLAINT CONTROL NUMBER: 24-AS-20211103141905
FACILITY NAME:DAGO RESIDENTIAL FACILITY #2 ELDERLYFACILITY NUMBER:
547209088
ADMINISTRATOR:SANCHEZ, CRISTINAFACILITY TYPE:
740
ADDRESS:3425 S. SAN JOAQUIN CT.TELEPHONE:
(559) 799-4086
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:6CENSUS: 6DATE:
11/08/2021
UNANNOUNCEDTIME BEGAN:
10:19 AM
MET WITH:Cristina Sanchez, AdministratorTIME COMPLETED:
01:40 PM
ALLEGATION(S):
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A staff person is sleeping in a bed that the resident purchased.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) M. Yang conducted an initial complaint investigation and met with Administrtor. LPA stated the purpose of the visit and reviewed the allegations.

During the course of the investigation, the Department conducted interviews and toured the facility. LPA interviewed staffs, clients, and spoke to regional center. It was confirmed that facility staff and C1 switched rooms and S1 slept on C1’s bed without informing Regional Center of the changes. S1 exhibit behaviors after the changed.

Based on interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED.

Exit interview conducted. As a COVID-19 precautionary measure, a copy of this report and appeal rights will be provided via email. Report signed on-site.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021
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
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
11/03/2021 and conducted by Evaluator Mai Yang
COMPLAINT CONTROL NUMBER: 24-AS-20211103141905

FACILITY NAME:DAGO RESIDENTIAL FACILITY #2 ELDERLYFACILITY NUMBER:
547209088
ADMINISTRATOR:SANCHEZ, CRISTINAFACILITY TYPE:
740
ADDRESS:3425 S. SAN JOAQUIN CT.TELEPHONE:
(559) 799-4086
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:6CENSUS: 6DATE:
11/08/2021
UNANNOUNCEDTIME BEGAN:
10:19 AM
MET WITH:Cristina Sanchez, AdministratorTIME COMPLETED:
01:40 PM
ALLEGATION(S):
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9
The administrator is rarely at the facility.
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) M. Yang conducted a subsequent complaint inspection on this date.

During the course of the investigation, the Department conducted interviews and toured the facility. LPA interviewed staff and clients. Based on the interviews conducted, clients and staff confirmed Administrator is at the facility throughtout the week for 2 to 3 hours a day.

Based on interviews conducted, the preponderance of evidence standard has not been met, therefore the above allegations are found to be UNSUBSTANTIATED.

Exit interview conducted. As a COVID-19 precautionary measure, a copy of this report will be provided via email. Report signed on-site.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021
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-20211103141905
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: DAGO RESIDENTIAL FACILITY #2 ELDERLY
FACILITY NUMBER: 547209088
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/08/2021
Section Cited
CCR
80072(a)(2)
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80071 (a)(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.

This requirement was not met:
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Facility moved the client back into his room back to his bed. POC cleared during the inspection.
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Based on interviews conducted, facility staff and C1 switched rooms and S1 slept on C1’s bed without informing Regional Center of the changes. S1 exhibit behaviors after the changed, this posses an immediately health and safety and personal rights risk to the client.
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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: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3