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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107209371
Report Date: 09/10/2026
Date Signed: 09/20/2026 10:44:23 AM

Unsubstantiated


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
01/21/2026 and conducted by Evaluator Sarah Hurt
COMPLAINT CONTROL NUMBER: 24-AS-20260121130218
FACILITY NAME:EVERGREEN COURTFACILITY NUMBER:
107209371
ADMINISTRATOR:ROYCHOUDHURY,MINAKSHIFACILITY TYPE:
740
ADDRESS:1415 WEST SCOTT AVENUETELEPHONE:
(559) 222-4876
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY:6CENSUS: 5DATE:
09/10/2026
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Administrator Zachary CostieTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Staff yells at a resident in care.
Staff is denying food to a resident in care.
Staff does not ensure that residents bedding is kept clean.
Staff left a resident in soiled clothing for a long period of time.
Staff are not meeting the hygiene needs of the residents in care.
Staff are locking a resident in a room.
Staff did not administer medication as prescribed.
Staff did not seek medical attention for a resident in care in a timely manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to deliver findings on the allegations listed above. LPA met with facility Administrator Zachary Costie, and explained the purpose of today's visit.

Regarding the allegation Staff yells at a resident in care. During the investigation, LPA conducted interviews with residents and staff. Resident 2 stated staff speaks to them in a regular tone and stated staff were not mean to residents. Residents interviewed generally reported feeling safe at the facility.Based on conflicting information obtained during interviews and insufficient corroborating evidence, there is not a preponderance of evidence to prove that staff yelled at a resident in care. 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.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2026
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
Control Number 24-AS-20260121130218
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: EVERGREEN COURT
FACILITY NUMBER: 107209371
VISIT DATE: 09/10/2026
NARRATIVE
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Regarding the allegation Staff is denying food to a resident in care. During the investigation, LPA conducted resident and staff interviews regarding food provided to residents. Resident 1 reported that staff sometimes denied his request for an additional banana after he had already received multiple, and told him he would need to wait until the next meal. Resident 2 stated that they receives enough food, staff provide their meals, and staff have not denied them any food. The investigation did not establish that residents were deprived of meals or sufficient food. 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.

Regarding the allegation Staff does not ensure that residents bedding is kept clean. During the investigation, LPA conducted resident interviews and made observations regarding resident bedding. Resident 3 reported that staff change his sheets. Resident 2 reported that staff wash their bedding. During a facility visit, LPA observed staff placing clean sheets on a resident’s bed. Staff reported that bedding is changed following residents’ showers. 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.

Regarding the allegation Staff left a resident in soiled clothing for a long period of time. Staff 1 described an occasion when Resident 3 requested to be changed while she was administering medications. Staff 1 reported that she informed Resident 3 she would return after completing the task and subsequently returned and changed him. Although Resident 3 reported experiencing delays in being changed, the investigation did not establish the length of time he remained wet or soiled or establish that staff failed to provide necessary incontinence care for a prolonged period. 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.



SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 24-AS-20260121130218
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: EVERGREEN COURT
FACILITY NUMBER: 107209371
VISIT DATE: 09/10/2026
NARRATIVE
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Regarding the allegation Staff are not meeting the hygiene needs of the residents in care. During the investigation, LPA interviewed residents regarding assistance with bathing and personal hygiene. Resident 3 confirmed that staff assist him with showers. Resident 1 reported receiving assistance with showers approximately two to three times per week. Resident 2 reported that they are able to perform some bathing and dressing independently and receives assistance from staff as needed. 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.

Regarding the allegation Staff are locking a resident in a room. During the investigation, LPA conducted interviews and observations regarding the allegation. The complaint did not identify specific dates, times, or circumstances regarding when the alleged incident occurred. LPA attempted to contact the reporting party to obtain additional information and clarification; however, the reporting party could not be reached.
Resident 1 stated he feels safe at the facility and has an exit near his room. Resident 2 reported that her door is left open and she is able to enter and exit her room. LPA inspected resident rooms and did not observe an exterior locking mechanism that would allow staff to lock a resident inside a room. Resident 4 was unable to provide sufficient information regarding the allegation. Licensing records reflect that a previous complaint involving Resident 4 being locked in their room was previously investigated and addressed. Due to the lack of specific dates and details in the present complaint, the investigation could not establish that the current allegation involved a separate occurrence. 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.

Regarding the allegation Staff did not administer medication as prescribed. During the investigation, LPA conducted interviews and reviewed available medication related information. The investigation did not identify a specific prescribed medication that was missed or administered contrary to a physician’s order. Information obtained during the investigation did not establish that a resident failed to receive prescribed medication due to the actions of facility staff. 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.




Regarding the allegation Staff did not seek medical attention for a resident in care in a timely manner. The Department investigated the allegation that staff did not seek timely medical attention for Resident 3 (R3). It was alleged that Resident 3 fell to the ground and was left there for an extended period of time and that staff failed to call 911 or obtain medical treatment until the following morning. During the investigation, LPA interviewed R3 and facility staff and reviewed documentation related to the incident. R3 did not report being left on the ground for an extended period of time and did not provide information indicating that staff refused or significantly delayed medical assistance following the incident. Documentation reviewed did not establish the length of time R3 was on the ground or demonstrate that R3 exhibited symptoms requiring an immediate emergency medical response that staff failed to provide. Although R3 subsequently received medical evaluation/treatment, the evidence obtained during the investigation was insufficient to establish that facility staff failed to seek timely medical attention. 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.

Exit interview conducted with facility, Administrator Zachary Costie, and copy of report provided
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3