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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 547209374
Report Date: 07/22/2024
Date Signed: 07/25/2024 08:32:04 AM

Unfounded


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
07/19/2024 and conducted by Evaluator Lisa Salazar
COMPLAINT CONTROL NUMBER: 24-AS-20240719161548
FACILITY NAME:GRAND OAKS ASSISTED LIVINGFACILITY NUMBER:
547209374
ADMINISTRATOR:SHELLHAMER, DAVIDFACILITY TYPE:
740
ADDRESS:999 NORTH M STREETTELEPHONE:
(559) 684-1001
CITY:TULARESTATE: CAZIP CODE:
93274
CAPACITY:85CENSUS: 46DATE:
07/22/2024
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Wendy Nunez, Residential Care CoordinatorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
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9
Staff did not provided care for resident
Staff did not shower and bathe resident
Staff did not change resident's bedding
INVESTIGATION FINDINGS:
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2
3
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5
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7
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9
10
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13
On 07/23/24, Licensing Program Analyst (LPA) arrived to the facility unannounced to conduct the required 10 day site inspection. LPA was greeted by Residential Care Coordinator (RCC), stated the purpose of the visit, and was allowed entry into the facility.

LPA requested the facility roster and did not observe resident's name that was reported in the allegations. LPA asked RCC to contact the Administrator next door at Grand Oaks Skilled Nursing Facility (SNF) to obtain a facility roster. Administrator of SNF, Michelle Lawrence, arrived at the facility with the SNF roster. LPA observed resident on SNF roster and it was verbally confirmed the resident does not live in the jurisdiction of CCL regulations. A cross report to CDPH has been made.

Based on the information received, the allegations are UNFOUNDED, meaning they are false, could not have happened, and/or without a reasonable basis. Therefore, we have dismissed the complaint.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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