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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157209479
Report Date: 07/13/2026
Date Signed: 07/14/2026 10:00:07 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
04/14/2026 and conducted by Evaluator Sarah Hurt
COMPLAINT CONTROL NUMBER: 24-AS-20260414160902
FACILITY NAME:RESIDENCY CLUB, THEFACILITY NUMBER:
157209479
ADMINISTRATOR:PATEL, MUKESHFACILITY TYPE:
740
ADDRESS:6717 THUNDER TRAIL DRTELEPHONE:
(661) 903-2448
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93313
CAPACITY:6CENSUS: 1DATE:
07/13/2026
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Licensee, Dr. Barnes, and Facility staff Shawn WaltonTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Unqualified staff are providing wound care to resident
Staff are not dispensing medications as prescribed
Staff did not obtain criminal record clearance before working at facility
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 Licensee Dr. Barnes and Facility staff Shawn Walton, and explained the purpose of today's visit.

Regarding the allegation Unqualified staff are providing wound care to resident. LPA conducted interviews, reviewed records, and made observations at the facility. During the facility visit on 04/16/2026 staff acknowledged that they were applying ointment to Resident 1's wound and replacing the dressing/bandage. Staff stated they routinely performed these tasks as part of residents care. Based on interviews conducted and observations, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2026
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 5
Control Number 24-AS-20260414160902
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: RESIDENCY CLUB, THE
FACILITY NUMBER: 157209479
VISIT DATE: 07/13/2026
NARRATIVE
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Regarding the allegation Staff are not dispensing medications as prescribed. During the investigation, staff stated they administer medications directly from weekly/monthly pill organizers prepared by resident family members and outside caregivers. Staff acknowledged they do not know the identity of the medications contained within the organizers and do not verify the contents against original pharmacy-labeled containers or physician orders prior to administration. LPA observed medications removed from their original labeled containers and placed into organizers. The facility was unable to provide centrally stored medication records or documentation verifying the medications being administered. Based on staff admissions, observations, and record review, the facility failed to ensure medications were administered according to physicians orders. The preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.


Regarding the allegation Staff did not obtain criminal record clearance before working at facility. LPA observed staff 1 at the facility with resident 2 present and no other facility staff. Staff 1 is not fingerprint cleared or associated to this facility,. Staff 2 is fingerprint cleared to work at the facility beginning April 06, 2026. Multiple witnesses interviewed confirmed Staff 2 began providing care to residents as early as January 2026. Based on interviews conducted, and LPA observation the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Exit interview conducted with facility Licensee, Dr. Barnes, and Facility staff Shawn Walton, and copy of report provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
04/14/2026 and conducted by Evaluator Sarah Hurt
COMPLAINT CONTROL NUMBER: 24-AS-20260414160902

FACILITY NAME:RESIDENCY CLUB, THEFACILITY NUMBER:
157209479
ADMINISTRATOR:PATEL, MUKESHFACILITY TYPE:
740
ADDRESS:6717 THUNDER TRAIL DRTELEPHONE:
(661) 903-2448
CITY:BAKERSFIELDSTATE:CAZIP CODE:
93313
CAPACITY:6CENSUS: 1DATE:
07/13/2026
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Licensee, Dr. Barnes and facility staff Shawn WaltonTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff are not assisting resident with medical appointments
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 Licensee Dr. Barnes, and explained the purpose of today's visit.

Regarding the allegation Staff are not assisting resident with medical appointments. LPA spoke with Witness 1 who provides 1 on 1 care for Resident 2. Witness 1 stated she is with Resident 2 daily from 10am to 03pm and takes her to all medical appointments. Winess 1 stated Resident 2 is not missing medical appointments. 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 Licensee, Dr. Barnes, and facility staff Shawn Walton, and copy of report provided.



Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2026
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 5
Control Number 24-AS-20260414160902
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: RESIDENCY CLUB, THE
FACILITY NUMBER: 157209479
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/13/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/14/2026
Section Cited
CCR
87631(a)(1)(A)
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87631 Healing Wounds (a) Except as specified in Section 87611(a), the licensee shall be permitted to accept or retain a resident who has a healing wound under the following circumstances:(1) When care is performed by or under the supervision of an appropriately skilled profession(A) The resident shall receive care for the pressure injury from a physician or an appropriately skilled professional. The following requirement has not been met as evidenced by:
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The Licensee will immediately cease allowing unlicensed staff to provide wound care to residents. The licensee shall ensure wound care is provided only by an appropriately skilled professional or under the supervision of an approprately skilled proffesional, as permitted under Title 22 Regulations.
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Based on interviews and observation facility staff was providing wound care to Resident 1, which poses an immediate health, safety , or personal rights risk to residents in care.
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Type A
07/14/2026
Section Cited
CCR
87465(4)
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87465 Incidental Medical and Dental Care (4) The licensee shall assist residents with self-administered medications as needed. The following requirements have not been met as evidenced by:
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The Licensee shall immediately discontinue the practice of administering medications from organizers that have been pre filled by outside caregivers without verification. All medications shall be maintained in their original pharmacy labeled containers, the licensee shall establish centrally stored medication records for each resident whose medication is being stored at this facility and send proof to LPA by POC date 07/14/2026.
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Based on observation, and interview Facility staff is administering medications to resident 1 and resident 2 that are removed from original container and placed in weekly organizers, which poses an immediate, health, safety, or personal rights risk to residents 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.
SUPERVISOR'S NAME: See Moua
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 24-AS-20260414160902
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: RESIDENCY CLUB, THE
FACILITY NUMBER: 157209479
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/13/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/14/2026
Section Cited
CCR
87355(a)
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87355 Criminal Record Clearance

(a) The Department shall conduct a criminal record review of all individuals specified in Health and Safety Code section 1569.17 and shall have the authority to approve or deny a facility license, or employment, residence, or presence in the facility, based upon the results of such review. The following requirement has not been as evidenced by:
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Licensee shall immediately remove all individuals without a crimninal record clearance or approved exemption from the facility and ensure they do not provide care or have contact with residents until the required criminal record clearance has been obtained.
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Based on interview and observation staff 1 and staff 2 have provided care to facility residents without fingerprint clearance, which poses an immediate, health, safety, or personal rights risk to residents 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.
SUPERVISOR'S NAME: See Moua
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5