547209374-9-13-2024-24-AS-BCHN-D9EPH2-20240924111910

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 547209374
Report Date: 09/13/2024
Date Signed: 09/13/2024 10:14:12 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
09/04/2024 and conducted by Evaluator Melinda Medina

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20240904155634

FACILITY NAME:	GRAND OAKS ASSISTED LIVING		FACILITY NUMBER:	547209374
ADMINISTRATOR:	SHELLHAMER, DAVID		FACILITY TYPE:	740
ADDRESS:	999 NORTH M STREET		TELEPHONE:	(559) 684-1001
CITY:	TULARE	STATE: CA	ZIP CODE:	93274
CAPACITY:	85	CENSUS: 49	DATE:	09/13/2024
		UNANNOUNCED	TIME BEGAN:	09:22 AM
MET WITH:	Wendi Valdez, Resident Care Coordinator		TIME COMPLETED:	10:35 AM

ALLEGATION(S):

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Licensee did not provide a copy of the resident's records to the resident's legal representative.

INVESTIGATION FINDINGS:

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On 9/12/2024, Licensing Program Analyst (LPA) M. Medina conducted an unannounced initial 10-day complaint visit. LPA introduced self and stated purpose of visit. David Shellhamer, Administrator was not available to conduct today's visit. LPA met with Wendi Valdez, Resident Care Coordinator.

This agency has investigated the complaint alleging Licensee did not provide a copy of the resident's records to the resident's legal representative. Based on the information received, Resident R1 passed away prior to the licensure of Grand Oaks Assisted Living on 06/06/24. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

No deficiencies cited.

Exit interview conducted and a copy of this report provided for facility

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024

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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